Medically Reviewed by Dr Jackie Lam (M.B.B.S. Singapore)

Fevers are a common occurrence in children and often serve as the body’s natural response to infection. However, when fevers become a recurring event, it can cause concern for parents and healthcare providers alike. 

Recurrent fevers, which are defined as episodes of fever occurring regularly over a period of time, can signal an underlying condition that requires further investigation. In this article, we’ll explore the potential causes of recurring fever in children, how to manage these episodes, and when to seek medical advice.

Understanding Recurring Fevers in Children

Children fever is a frequent issue in pediatric care, but recurring fevers follow a different pattern than typical, short-lived fevers associated with minor infections. In cases of recurring fever, a child experiences multiple episodes of fever separated by periods of normal temperature. These fevers can happen in predictable cycles or irregularly, and they may or may not be accompanied by other symptoms.

The underlying cause of recurring fever can vary widely, ranging from common infections to rare genetic syndromes. It’s essential to identify the pattern of the fever, any accompanying symptoms, and the duration of the episodes to narrow down potential causes.

Common Causes of Recurring Fever in Children

1. Viral and Bacterial Infections

One of the most common causes of recurring fever in children is persistent or relapsing infections. Viral infections, such as Epstein-Barr virus (EBV) or cytomegalovirus (CMV), can cause prolonged fevers that come and go over weeks or months. Similarly, chronic bacterial infections, such as urinary tract infections (UTIs) or sinusitis, may lead to cyclical fever episodes as the body attempts to fight off the infection.

In these cases, the child may display other symptoms during fever episodes, such as fatigue, sore throat, or swollen lymph nodes. Often times, children with recurring fever may also have back-to-back infections, where the fever might stop for a few days before recurring with worsening of symptoms. Diagnosing the underlying infection often requires blood tests, urine tests, or imaging studies, depending on the suspected source of infection.

2. Periodic Fever Syndromes

Periodic fever syndromes are a group of rare genetic disorders characterized by recurrent episodes of fever without an identifiable infectious cause. These conditions typically begin in childhood and are thought to be caused by abnormal functioning of the immune system. One of the most well-known conditions in this group is Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome.

Children with periodic fever syndromes may experience fevers at regular intervals, often accompanied by symptoms such as mouth ulcers, sore throat, or swollen lymph nodes. These fever episodes can be distressing, but they usually resolve on their own and do not cause long-term harm. However, managing the symptoms and reducing the frequency of the fevers often requires medical intervention.

3. Autoimmune and Inflammatory Conditions

Autoimmune diseases, in which the immune system mistakenly attacks the body’s own tissues, can also lead to recurring fevers in children. Conditions like juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) are examples of autoimmune disorders that may present with recurrent fever episodes.

In addition to fever, children with autoimmune or inflammatory conditions often experience joint pain, fatigue, rashes, and other systemic symptoms. Diagnosing these conditions involves specialized blood tests and may require referral to a pediatric rheumatologist.

4. Malignancy

Rarely, fever might be the first symptom in a child who has cancer. There are certain characteristics of the fever and accompanying symptoms that might raise the clinical suspicion of cancer as a cause. At times, there might be a history of similar cancers in the family too. The evaluation for malignancy is an extensive one and may necessitate imaging. 

How to Manage Recurring Fevers in Children

Managing these fever episodes can be challenging, especially when the cause is unclear. Here are some steps parents and caregivers can take to manage recurring fevers effectively:

1. Keep a Symptom Diary

Keeping track of your child’s fever episodes can provide valuable information for your healthcare provider. Note when the fevers occur, their duration, and any accompanying symptoms such as rashes, joint pain, or gastrointestinal issues. Documenting this information can help identify patterns and potential triggers that may be contributing to the fevers.

2. Focus on Comfort

During a fever episode, it’s essential to keep your child comfortable and hydrated. Offer plenty of fluids to prevent dehydration, and dress your child in light clothing to help regulate their body temperature. Over-the-counter fever reducers, such as acetaminophen or ibuprofen, can be used to alleviate discomfort, but always follow dosing instructions carefully and consult with your healthcare provider if you have concerns.

3. Seek Medical Advice for Diagnosis and Treatment

If your child’s fevers persist or follow a recurring pattern, it’s crucial to consult a healthcare provider. The provider will likely perform a thorough physical examination and order tests to determine the cause of the recurring fevers. Diagnostic tests may include blood work to check for infections, autoimmune markers, or inflammatory conditions, as well as imaging studies like X-rays or ultrasounds if a specific area of the body is affected.

In cases where periodic fever syndrome is suspected, your provider may recommend specific treatments to help manage the condition. For instance, corticosteroids are sometimes used to reduce the frequency and severity of fever episodes in conditions like PFAPA. Early intervention and appropriate treatment can help reduce the impact of recurring fevers on your child’s health and well-being.

4. Recognize When to Seek Emergency Care

While most recurring fevers are not medical emergencies, certain signs and symptoms should prompt immediate medical attention. Seek emergency care if your child exhibits any of the following alongside fever:

• Difficulty breathing or rapid breathing.
• Persistent vomiting or inability to keep fluids down.
• Severe headache or stiff neck.
• Lethargy or unresponsiveness.
• Unexplained rash, especially if it spreads quickly or is accompanied by bruising.

These symptoms could indicate a more serious condition, such as sepsis or meningitis, and require prompt medical evaluation.

When to Be Concerned About Recurring Fever

Recurring fevers in children can be stressful for parents, but it’s essential to stay informed and proactive about your child’s health. In many cases, recurring fevers can be managed with proper care and monitoring. However, if the fevers persist for several weeks, follow a regular pattern, or are accompanied by concerning symptoms, it’s time to seek further evaluation from a healthcare provider.

Some indicators that your child’s recurring fever may require additional medical investigation include:

• Fevers that last for more than 7 days.
• Fevers that occur in regular cycles (e.g., every few weeks or months).
• Fevers accompanied by unusual symptoms, such as weight loss, prolonged fatigue, or joint pain.
• Fevers that do not respond to typical fever-reducing medications.

Early detection and treatment are key to managing underlying conditions that may be contributing to recurring fever. With the right diagnosis, most causes of recurrent fever can be treated or managed to minimize their impact on your child’s health.

Get Expert Help for Your Child’s Recurring Fever at Keystone Medical

Managing children with recurring fever can be complex and challenging for parents, but understanding the potential causes and taking appropriate steps to monitor and address symptoms can make a significant difference. 

Keeping detailed records of your child’s fever episodes and seeking timely medical care are essential in identifying the root cause and ensuring proper treatment.

If your child is experiencing recurring fevers and you are unsure of the cause, visit Keystone Medical for expert consultation and care. Our experienced team can help diagnose and manage your child’s condition, ensuring they receive the best possible treatment.

References

Clevelandclinic.org. 2023. Recurrent Fever Syndromes (Formerly Known as Periodic Fever Syndromes). https://my.clevelandclinic.org/health/diseases/17354-periodic-fever-syndrome

Ncbi.nlm.nih.gov. 2017. Approach to Recurrent Fever in Childhood. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5638471/

Healthline.com. 2022. What is a Periodic Fever Syndrome?. https://www.healthline.com/health/periodic-fever-syndrome#bottom-line