Toddlers frequently come down with fevers as they encounter infections, bacteria and bugs new to their still-developing immune systems–this is to be expected. When a small child develops periodic fevers that defy treatment, however, he may suffer from one of several genetic conditions that predispose him to these fevers. When parents know about these conditions, they, along with their doctors, can decide if further testing is necessary.
Description of Periodic Fevers
A fever is an elevated temperature higher than 100.4 degrees Fahrenheit. When your child develops a fever, her body is making many more white blood cells in response to bacteria and germs from viruses. The white blood cells her body is making target these germs, overwhelming and killing them. As her body is responding to the organisms, it is also producing antibodies in preparation for future infections, says the Children’s Memorial Hospital website.
If your child suffers from viral infections one after another, she may develop periodic fevers. As she is exposed to various bugs and germs, her immature immune system is beginning to recognize the bugs to which she is being exposed–this is a normal response. If she begins to develop fevers on a recognizable schedule, she may have a “periodic fever” condition. Your doctor can help isolate what may be causing your child to come down with periodic fevers.
PFAPA
PFAPA means “periodic fever, aphthous ulcers, pharyngitis and adenitis." These fevers usually register between 102 to 103 degrees Fahrenheit and occur every three to six weeks, lasting two to four days, states the Children’s Memorial Hospital website. The child may not have any other symptoms and recovers quickly. PFAPA resolves without treatment.
Other Causes of Periodic Fevers
PFAPA may have a genetic cause, including hyperimmunoglobulinemia D periodic fever syndrome; TNF-receptor associated periodic fever syndrome; familial Mediterranean fever, which is an inherited, inflammatory disorder causing inflammation of the lungs, joints and abdomen; and cyclic neutropenia, a rare blood disorder including low levels of some white blood cells. All of these disorders cause periodic fever. If your child develops periodic fevers with mouth sores, a general ill feeling, swollen lymph glands and a sore throat, your doctor can determine if he suffers from something more specific than run-of-the-mill viruses.
Connection to Inflamed Tonsils
Some children come down with high fevers ranging from 104 to 105 degrees Fahrenheit. The fevers do not respond to acetaminophen or ibuprofen, but go away after four to five days, then come back within one to one and a half months. In response to his own daughter's periodic fever syndrome, Dr. Greg Licameli of Children's Hospital Boston learned about two reports on children of European ancestry who suffered from PFAPA. These children were examined for viral, fungal and bacterial illnesses; only two of the children tested positive for group A hemolytic streptococcus. Treatment with antibiotics and nonsteroidal anti-inflammatory medications was ineffective. Oral prednisone controlled symptoms during a fever episode, but did not prevent relapses.
In his own practice, Licameli has treated 60 children diagnosed with PFAPA, recommending that the children have their tonsils removed. These children no longer suffer from periodic fevers. Licameli believes the tonsils may “harbor a chronic indolent infection to which the immune system is hypersensitive.”
References
- Children’s Memorial Hospital: Periodic Fevers
- Children’s Hospital Boston: Pediatric Views; Surgery Found to Cure Mysterious, Unexplained Fevers; June 2008
- MayoClinic.com; Familial Mediterranean fever; July 2010
- Providence Health & Services: Neutropenia, Cyclic
- Orphanet; Marshall’s Syndrome or PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis) Syndrome; Drs. Marco Berlucchi, et al.; January 2004
