When Fever Doesn’t Go Away Understanding Recurrent Fevers in Children
📌 “Not all fevers are infections — and not all infections are simple colds.”
🔹 Introduction
Fever is one of the most common reasons parents take their child to the doctor. But when fever keeps coming back — sometimes without any other clear symptoms — it raises concern and frustration.
Recurrent fever in children can be a sign of chronic or hidden conditions, not just repeated viral infections. Understanding the difference is essential for early diagnosis and peace of mind.
In this article, we’ll cover:
- What is considered recurrent fever
- Common and rare causes
- Warning signs that require medical evaluation
- Diagnosis and tests
- Treatment options and when to worry
🌡️ What Is Recurrent Fever?
Recurrent fever means multiple episodes of fever (temperature ≥38°C or 100.4°F), separated by days or weeks of normal temperature in between.
It differs from:
- Persistent fever: a single, continuous fever lasting more than 7–10 days
- Intermittent fever: fever that comes and goes within a short illness (like malaria)
Recurrent fever typically means:
- 3 or more episodes in 6 months
- Fever episodes lasting 3–7 days
- Fever without clear cause (like sore throat, cough, etc.)
⚠️ Common Causes of Recurrent Fever in Children
1. Recurrent Viral Infections
- Young children catch 6–10 viral infections per year
- Especially common in daycare or school
- Usually associated with runny nose, cough, mild diarrhea
🟢 Reassuring sign: The child is well in between episodes and continues to grow and play normally.
2. Urinary Tract Infections (UTIs)
- May cause high fever without obvious symptoms
- More common in girls or children with urinary tract abnormalities
- Needs urine analysis and culture
3. Tonsillitis or Sinusitis
- Chronic or partially treated infections can flare up repeatedly
- Symptoms may be mild or overlooked
4. Tuberculosis (TB)
- Causes low-grade fever, night sweats, weight loss
- Considered if there’s TB contact or travel to high-risk areas
5. Autoinflammatory Syndromes (Periodic Fever Syndromes)
-
PFAPA Syndrome (Periodic Fever, Aphthous ulcers, Pharyngitis, Adenitis)
- Starts before age 5
- Fever every 3–6 weeks, lasts 3–5 days
- Child is healthy between episodes
-
Familial Mediterranean Fever (FMF)
- Common in Mediterranean populations (including Arab communities)
- Fever with abdominal pain, joint pain, sometimes rash
6. Hidden Infections
- Dental abscesses, ear infections, or osteomyelitis (bone infection)
- Often missed without specific examination or imaging
7. Immunodeficiency
- Children with low immunity may have frequent infections
- Signs include poor growth, chronic diarrhea, recurrent pneumonia or skin infections
8. Malignancy (Very Rare)
- Leukemia or lymphoma can present with persistent or recurrent fever
- Often associated with fatigue, pallor, bruising, swollen glands, weight loss
🧪 Diagnosis: What Tests Might Be Needed?
If your child has repeated fevers without clear cause, your pediatrician may recommend:
1. Basic Blood Tests
- CBC (to check white blood cells, anemia)
- CRP and ESR (inflammation markers)
- Ferritin and LDH (sometimes elevated in inflammation or malignancy)
2. Urine Tests
- Urine analysis and culture to rule out UTI
3. Throat or Nasal Swabs
- For recurrent strep or viral infections
4. TB Testing
- Tuberculin skin test (PPD) or TB blood test (IGRA)
5. Immunology Panel
- To check immune function if immunodeficiency is suspected
6. Genetic Testing
- For periodic fever syndromes like FMF (MEFV gene)
🔍 When Should You Worry?
Seek medical attention if:
- Fever occurs more than once a month for no clear reason
- Each fever lasts more than 5 days
- The child has painful mouth sores, swollen lymph nodes, or joint pain
- There are signs of poor growth, weight loss, pallor, or fatigue
- Family history of autoimmune or autoinflammatory diseases
💊 Treatment Depends on the Cause
- Recurrent viral infections: No treatment needed; reassurance is key
- UTIs: Antibiotics, and possibly imaging for structural issues
- PFAPA syndrome: Responds well to single-dose steroids during attacks; sometimes tonsillectomy helps
- FMF: Treated with colchicine to reduce attacks and prevent long-term complications
- TB or bacterial infections: Need specific antibiotics for weeks or months
- Immunodeficiency: May require immunoglobulin therapy
🧠 Tips for Parents
- Track the fevers: Keep a diary of dates, temperature, duration, and symptoms
- Document in-between periods: Are they completely healthy, or low energy?
- Don’t overuse antibiotics: Not all fevers need medication
- Ask for referrals: If fevers persist without explanation, consult a pediatric infectious disease or rheumatology specialist
📈 Outlook
Most children with recurrent fever have benign or manageable conditions, especially if they're growing well and have normal energy between episodes. The key is early medical evaluation, proper follow-up, and targeted testing.
📚 References
- Feder HM et al. Evaluation and Management of Fever Without Source in Children. Pediatrics in Review, 2019.
- Stojanov S, et al. Periodic fever syndromes in childhood. Ann Rheum Dis, 2017.
- NIH – National Institute of Allergy and Infectious Diseases.
- Thomas KT, et al. PFAPA Syndrome: Clinical Overview. J Pediatr, 2012.