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Persistent fever in child. Understanding Recurrent Fever in Children: Causes, Diagnosis, and Management

by alexxlab

What are the common causes of recurrent fever in children. How is recurrent fever diagnosed in pediatric patients. What are the treatment options for persistent fever in children. When should parents seek medical attention for a child with recurring fever. How can recurrent fever impact a child’s overall health and development. What are the potential complications of untreated recurrent fever in children. Are there any preventive measures to reduce the occurrence of recurrent fever in kids.

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Defining Recurrent Fever in Pediatric Patients

Recurrent fever in children is a challenging medical condition that often perplexes both parents and healthcare providers. But what exactly constitutes a recurrent fever? A recurrent fever is typically defined as repeated episodes of fever that occur over an extended period, with intervals of normal body temperature between episodes. These fever patterns can vary in frequency, duration, and intensity, making diagnosis and management complex.

The threshold for defining a fever in children is generally considered to be a body temperature of 38°C (100.4°F) or higher. However, it’s important to note that normal body temperature can fluctuate throughout the day and may differ slightly between individuals. In the context of recurrent fevers, healthcare providers often look for a pattern of fever episodes that occurs regularly or semi-regularly over a period of weeks, months, or even years.

Characteristics of Recurrent Fever

  • Multiple episodes of fever within a defined period
  • Intervals of normal body temperature between fever episodes
  • Fever episodes may be accompanied by other symptoms
  • Duration and intensity of fever can vary between episodes
  • Pattern may be regular or irregular

Understanding the nuances of recurrent fever is crucial for proper diagnosis and treatment. Healthcare providers often rely on detailed fever logs and symptom descriptions from parents to identify patterns and potential underlying causes.

Common Causes of Persistent Fever in Children

Recurrent fever in children can stem from a wide range of underlying conditions. Identifying the root cause is essential for effective treatment and management. Here are some of the most common causes of persistent fever in pediatric patients:

Infectious Causes

  1. Viral infections (e.g., Epstein-Barr virus, cytomegalovirus)
  2. Bacterial infections (e.g., urinary tract infections, sinusitis)
  3. Parasitic infections (e.g., malaria in endemic areas)
  4. Recurrent respiratory infections

Non-Infectious Causes

  1. Autoinflammatory disorders (e.g., Familial Mediterranean Fever)
  2. Autoimmune diseases (e.g., juvenile idiopathic arthritis)
  3. Periodic fever syndromes
  4. Malignancies (e.g., leukemia, lymphoma)

It’s important to note that in some cases, the cause of recurrent fever remains unidentified despite extensive evaluation. These cases are often referred to as fever of unknown origin (FUO).

Diagnostic Approaches for Recurrent Fever in Children

Diagnosing the underlying cause of recurrent fever in children often requires a systematic and comprehensive approach. Healthcare providers typically employ a combination of clinical evaluation, laboratory tests, and imaging studies to pinpoint the source of persistent fever.

Clinical Evaluation

The diagnostic process usually begins with a thorough medical history and physical examination. Physicians pay close attention to the pattern of fever, associated symptoms, and any potential environmental or familial factors that may contribute to the recurrent episodes.

Laboratory Tests

  • Complete blood count (CBC) to assess for infections or hematological disorders
  • C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to evaluate inflammation
  • Blood cultures to identify potential bacterial infections
  • Viral serologies to detect specific viral infections
  • Autoantibody tests for autoimmune conditions

Imaging Studies

Depending on the clinical presentation and initial test results, various imaging studies may be recommended:

  • Chest X-ray to evaluate for respiratory infections or chest masses
  • Abdominal ultrasound to assess for intra-abdominal pathologies
  • CT or MRI scans for more detailed imaging when necessary

In some cases, genetic testing may be performed to identify specific periodic fever syndromes or other inherited conditions associated with recurrent fever. The diagnostic process often requires patience and collaboration between healthcare providers and families, as identifying the underlying cause can be challenging and time-consuming.

Treatment Strategies for Persistent Fever in Pediatric Patients

The treatment of recurrent fever in children is highly dependent on the underlying cause. Once a diagnosis is established, healthcare providers can tailor the treatment approach to address the specific condition. However, in cases where the cause remains unknown, symptomatic management and supportive care become the primary focus.

Targeted Treatments

  • Antibiotics for bacterial infections
  • Antiviral medications for specific viral infections
  • Immunomodulators for autoinflammatory disorders
  • Disease-modifying antirheumatic drugs (DMARDs) for autoimmune conditions
  • Chemotherapy or targeted therapies for malignancies

Symptomatic Management

When the underlying cause is unclear or during acute fever episodes, symptomatic management is crucial for the child’s comfort and well-being:

  • Antipyretic medications (e.g., acetaminophen, ibuprofen) to reduce fever and alleviate discomfort
  • Adequate hydration to prevent dehydration
  • Rest and supportive care to promote recovery

It’s important to note that the use of antipyretic medications should be based on the child’s overall condition and comfort level, rather than solely on the temperature reading. Parents should follow their healthcare provider’s recommendations regarding the appropriate use of these medications.

Long-term Management

For children with chronic conditions causing recurrent fever, long-term management strategies may include:

  • Regular follow-up appointments with specialists
  • Ongoing monitoring of disease activity and potential complications
  • Adjustments to medication regimens as needed
  • Patient and family education about the condition and its management

The goal of treatment is not only to manage the fever itself but also to address the underlying condition and improve the child’s overall quality of life. A multidisciplinary approach involving various specialists may be necessary for optimal management of complex cases.

Impact of Recurrent Fever on Child Development and Well-being

Persistent or recurrent fever in children can have significant implications for their overall health, development, and quality of life. Understanding these potential impacts is crucial for healthcare providers and parents alike to ensure comprehensive care and support for affected children.

Physical Impact

Recurrent fever episodes can take a toll on a child’s physical health and development:

  • Fatigue and decreased energy levels
  • Potential growth delays or weight loss due to decreased appetite during fever episodes
  • Increased susceptibility to other infections due to a weakened immune system
  • Physical discomfort and pain associated with fever and underlying conditions

Educational Impact

Frequent illness and medical appointments can disrupt a child’s education:

  • Increased school absenteeism
  • Difficulty keeping up with coursework
  • Potential impact on academic performance and learning outcomes

Psychosocial Impact

The chronic nature of recurrent fever can affect a child’s emotional well-being and social interactions:

  • Anxiety or depression related to frequent illness and medical procedures
  • Social isolation due to missed activities and concerns about illness
  • Potential impact on self-esteem and body image
  • Stress on family relationships and dynamics

Recognizing these potential impacts allows healthcare providers and families to implement supportive measures that address not only the medical aspects of recurrent fever but also the child’s overall well-being. This may include psychological support, educational accommodations, and strategies to maintain social connections despite frequent illness.

When to Seek Medical Attention for Recurrent Fever in Children

While occasional fevers are common in children and often resolve on their own, recurrent or persistent fevers warrant medical attention. Parents and caregivers should be aware of certain signs and symptoms that indicate the need for prompt medical evaluation.

Red Flags for Immediate Medical Attention

  • Fever in infants under 3 months of age
  • Fever accompanied by severe headache, neck stiffness, or confusion
  • Difficulty breathing or chest pain
  • Severe abdominal pain
  • Unusual rashes, especially those that don’t blanch under pressure
  • Signs of dehydration (e.g., decreased urination, dry mouth, sunken eyes)
  • Persistent vomiting or inability to keep fluids down

Indicators for Follow-up with Healthcare Provider

Even if the above red flags are not present, parents should consider seeking medical advice if:

  • Fever persists for more than 3-5 days
  • There is a pattern of recurring fever episodes with no clear cause
  • The child experiences significant discomfort or changes in behavior during fever episodes
  • There are concerns about the child’s growth, development, or overall well-being

It’s important for parents to trust their instincts. If they feel something is not right with their child, even if they can’t pinpoint exactly what it is, it’s always appropriate to seek medical advice. Healthcare providers can offer reassurance, perform necessary evaluations, and provide guidance on managing recurrent fever episodes.

Preventive Measures and Home Management of Recurrent Fever

While preventing all instances of recurrent fever may not be possible, especially when caused by underlying medical conditions, there are steps that families can take to manage fever episodes at home and potentially reduce their frequency or severity.

General Preventive Measures

  • Maintaining good hygiene practices, including regular handwashing
  • Ensuring up-to-date vaccinations
  • Promoting a healthy lifestyle with balanced nutrition and adequate sleep
  • Avoiding exposure to known triggers (if identified)
  • Managing stress, which can impact immune function

Home Management Strategies

When a fever episode occurs, the following measures can help manage symptoms and promote comfort:

  • Providing plenty of fluids to prevent dehydration
  • Dressing the child in lightweight, breathable clothing
  • Keeping the room temperature comfortable, not too warm
  • Using a lukewarm compress or sponge bath to help cool the body (avoid cold water, which can cause shivering)
  • Administering over-the-counter fever reducers as directed by a healthcare provider

Monitoring and Documentation

Keeping detailed records of fever episodes can be invaluable for diagnosis and management:

  • Tracking fever patterns, including onset, duration, and peak temperatures
  • Noting associated symptoms or potential triggers
  • Recording the effectiveness of home management strategies
  • Maintaining a log of medications administered

This information can help healthcare providers identify patterns and make more informed decisions about diagnosis and treatment. It’s important to remember that while these measures can help manage fever episodes, they do not address the underlying cause of recurrent fever. Regular follow-up with healthcare providers is essential for comprehensive management and to address any changes in the child’s condition.

Recurrent Fever in Children – PMC

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Kids Health Information : Fever in children

This fact sheet is available in the following languages: 
Arabic,
Assyrian,
Burmese,
Chinese (simplified),
Chinese (traditional),
English, 
Karen,
Persian,
Somali,
Turkish and
Vietnamese.

If you are concerned your child has COVID-19 please call the dedicated hotline on 1800 675 398 or visit www.dhhs.vic.gov.au/coronavirus for more information.

    Fever (a high temperature) is common in children. Fever is a normal response to many illnesses, the most common being an infection in the body. Fever itself is usually not harmful – in fact, it helps the body’s immune system fight off infection.

    While fevers can be concerning for parents, doctors will usually be more concerned about what is causing the fever, and not what the child’s temperature is. It is more important for you to monitor any symptoms of the underlying illness, rather than the fever itself.

    Signs and symptoms of fever

    Your child has a fever when their temperature reads above 38°C on a thermometer.

    Your child may also be:

    • unwell and hot to touch

    • irritable or crying

    • more sleepy than usual

    • vomiting or refusing to drink

    • shivering

    • in pain

    If your baby is under three months and has a fever above 38°C, then you should see a doctor, even if they have no other symptoms.

    Taking your child’s temperature

    There are a number of ways you can take a child’s temperature. Each method measures your child’s temperature in a different way, and the results can vary depending on the type of thermometer you use. Different methods include:

    • infrared forehead thermometer

    • under the arm or under the tongue with a digital, mercury or alcohol thermometer

    • ear (tympanic) thermometer

    • plastic tape thermometers used on the forehead (these are not recommended as they are not reliable).

    Some thermometers are more suitable for particular age groups so you should always read and follow the manufacturer’s directions to get an accurate reading. You can also ask your Maternal and Child Health Nurse, GP or pharmacist to show you how to use your thermometer. Do this before you need it.

    Febrile seizures

    Some children can have seizures (a ‘fit’) when they have a fever. These are called febrile seizures. Your child may have a febrile seizure if their temperature goes up suddenly. Sometimes, a seizure happens when parents don’t actually know their child has a fever. Febrile seizures are common and do not usually cause any long term health effects. See our fact sheet

    Febrile seizures.

    Care at home

    Infections that produce fever can be caused by different sorts of germs.  Most are caused by viruses and don’t need any treatment.  A few are caused by bacteria, which are treated with antibiotics. Antibiotics do not work on viruses

    Lowering your child’s fever will not help treat the underlying illness more quickly. 

    If your child seems well and is happy, there is no need to treat a fever. If your child is miserable, there are things you can do to help them to feel more comfortable:

    • Give your child frequent small drinks. Many children refuse to eat when they have a fever. This is not a problem, as long as they stay hydrated

    • If your breastfed child is younger than six months, offer extra breastfeeds

    • If your formula-fed child is younger than six months, offer the usual amount of formula

    • If your baby is older than six months, keep breastfeeding or bottle-feeding. You can also offer your child water or oral rehydration solutions. 

    • You might need to give your child smaller amounts of fluid, but more often. 

    • Give your child paracetamol and/or ibuprofen if the fever is making them miserable or they have other symptoms, such as a sore throat. Carefully follow the dosage instructions on the packaging. Do not give ibuprofen to babies under three months old or to any child who is dehydrated. Never give aspirin to children. See our fact sheet

      Pain relief for children.

    • Try wiping your child’s forehead with a sponge or facewasher soaked in slightly warm water to help cool them down. It’s important they don’t become too cold or uncomfortable when you do this. Cold baths or showers are not recommended.

    • Dress your child in enough clothing so that they are not too hot or cold. If your child is shivering, add another layer of clothing or a blanket until they stop.

    Watch your child for signs that their illness is getting worse.

    When to see a doctor

    If your baby is under three months old and has a fever above 38°C, even if they have no other symptoms, then you should see a GP.

    If your child is immunocompromised (has a weakened immune system) for any reason and has a fever above 38°C, you should seek immediate care from your doctor or hospital emergency department.

    For all other children, take them to see a GP if their temperature is above 38°C and they have any of the following symptoms:

    • a stiff neck or light is hurting their eyes

    • vomiting and refusing to drink much

    • a rash

    • more sleepy than usual

    • problems with breathing

    • pain that doesn’t get better with pain relief medication.

    Also take your child to a GP if they:

    • have had any fever for more than two days and there’s no obvious cause

    • seem be getting more unwell

    • have had a febrile seizure

    Key points to remember

    • A fever is when a child’s temperature is 38°C or higher

    • Fevers are common in children

    • A fever itself rarely causes harm and can help fight an infection

    • If your child seems well and is happy, there is no need to treat a fever.

    • If your child is under three months and has a fever above 38°C, take them to the doctor, even if they have no other symptoms.

    • Take your child to the doctor if they seem to be getting worse or have a prolonged fever

    For more information

    • Kids Health Info fact sheet:
      Febrile seizures

    • Kids Health Info fact sheet:
      Pain relief for children – paracetamol and ibuprofen.

    • Kids Health Info fact sheet:
      Dehydration

    • Raising Children’s Network:
      Taking your child’s temperature

    • See your GP or Maternal and Child Health Nurse

    Common questions our doctors are asked

    Should I be worried about my child’s fever?

    Doctors do not focus on fever in a child. They are more concerned about how your child looks and feels – if your child is not drinking, is lethargic and not themselves, or they have had a persistent fever for two or more days, that is when a doctor may try to work out what is causing the fever, and may require a blood test or urine sample.

    Can teething cause a fever?

    Children who are teething may have a fever of up to 38°C. However, a temperature greater than 38°C should never just be attributed to teething. It is more likely that an infection is present.

    Even after pain relief, my child has a fever. Should I be worried?

    Not if your child is feeling better and their other symptoms have improved. Paracetamol and ibuprofen may not make the fever go away, but the aim is to make your child feel better. If the fever has lasted for more than two days without getting better, see a doctor.

    When I feel sick, my GP advises me to take aspirin. Can I also use this for my child?

    Aspirin should never be given to a child to help manage their fever. It can lead to a dangerous condition called Reye syndrome. It should only be given when specifically recommended by a doctor. Paracetamol or ibuprofen can be used instead.

    Developed by The Royal Children’s Hospital General Medicine and Emergency departments, and Centre for Community Child Health. We acknowledge the input of RCH consumers and carers.

    Reviewed April 2021. 

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit 
    www.rchfoundation.org.au.

    Signs of hay fever and other types of fever. Causes, treatment – clinic “Dobrobut”

    Main

    Medical Library Dobrobut

    Publication date: 2019-11-12

    Signs of hay fever and other types of fever

    An increase in body temperature accompanied by chills is called a fever. This condition indicates the presence of a pathological process in the body. Such hyperthermia in a child and an adult should be diagnosed and stopped in time, as it can be fatal.

    Types of fever

    In medicine, there are several types of fever:

    • according to the factor that provoked hyperthermia – infectious and non-infectious;
    • according to the degree of body temperature increase – subfebrile, febrile, pyretic and hyperpyretic;
    • according to the duration of the increase in body temperature – subacute, acute and chronic.

    In addition, there are such types of fever as constant, undulating, intermittent, irregular and recurrent.

    In a narrower sense, fever is a nosological unit (disease) in which, in addition to fever and chills, other signs are observed. Often these diseases can be life-threatening, such as Chikungunya, West Nile and Ebola.

    Symptoms characteristic of various fevers

    Other symptoms may be observed in fevers. Let’s characterize some of these diseases:

    1. Ebola. A viral disease that is rapidly spreading among people. The source of infection are mice, rats, gorillas, forest antelope and other mammals. The incubation period of the disease lasts from 2 to 21 days, and then the pathology begins to develop rapidly. In addition to an increase in body temperature, there are severe headaches and muscle pain, diarrhea and discomfort in the intestinal area.
    2. Hay fever. This is an allergic reaction of the body to plant pollen. Signs of hay fever: frequent sneezing, significant nasal discharge, increased tearing. Against the background of these symptoms, an increase in body temperature may be observed, but it is insignificant and does not last long, it is stopped by antipyretic drugs.
    3. Dengue fever. This is a viral disease. The virus is transmitted by mosquitoes. The incubation period averages 3-15 days. Signs of pathology include an increase in body temperature up to 39-40 degrees Celsius, chills, rashes on the skin, pain in the bones and joints. As the disease progresses, hemorrhages, subcutaneous hematomas, and frequent vomiting occur.
    4. White fever. This condition is more common in childhood. Symptoms of white fever are characteristic: against the background of an increase in body temperature, the skin becomes pronounced pale, which is associated with the outflow of blood from small vessels located in the skin. The causes of white fever are varied. In particular, this is a viral infection of the body.
    5. Congo-Crimea hemorrhagic fever. The disease is viral in nature, it always begins acutely – with severe headaches, chills, fever up to 39-40 degrees Celsius, hematomas and skin rashes. With the progression of the disease, there are violations in the work of the kidneys.
    6. Hemorrhagic fever with renal syndrome (popular name – mouse fever). With this pathology, the kidneys are the first to be affected. Then there are severe pains in the lumbar region, impaired urination (it can be arbitrary, frequent or completely absent) – typical symptoms of mouse fever in men and women.

    Often a person has a fever, weakness and headaches for several days, but no pathological processes will be revealed during the examination. In this case, a diagnosis of “Fever of unknown origin” is made, requiring constant monitoring of the patient and symptomatic therapy.

    Fever is a condition when the patient is thrown either into heat or into cold. In this condition, you should definitely consult a doctor.

    Treatment of adult dengue and other fevers

    Treatment of febrile illnesses requires serious medication. In this case, not only antipyretics are used. So, in the treatment of dengue fever in adults and other types of fever, powerful antiviral drugs are used.

    There are also conditions that should not be confused with fever. Why do women throw it in the heat, then in the cold? This is a pronounced sign of menopause, which requires medical correction.

    Any fever accompanied by chills should be reported to a doctor. You can make an appointment with experienced specialists on our website Dobrobut.com. From them you can get more detailed information about fevers – for example, what are the features of the yellow fever vaccination in a child.

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    Temperature 37 °C in an asymptomatic child

    Physiological conditions are not the only cause of low-grade fever. In adults, a similar temperature reaction may occur in certain diseases 3 .

    Colds

    Among all the causes of a temperature of 37 ° C, acute respiratory viral infections (ARVI) rank first 6 . During the year, almost every adult gets ARVI from 2 to 4 times, and children over 6 years old (schoolchildren) – about 4-5 times 7 . Most often, the culprits are rhinoviruses, which cause 80% of ARVI cases in the autumn-winter period 6 .

    Most adults tolerate colds easily, continue to lead a normal life 7 , despite the appearance of itchy nose, runny nose (sneezing, mucous discharge from the nose), coughing and other symptoms. In this case, fever is usually absent or the body temperature rises slightly above 37 °C 6 and lasts for 1-2 days 11 .

    You can’t bear a cold on your feet! Take sick leave and follow your doctor’s instructions. This way you can avoid complications.

    Preservation of low-grade fever for more than 7 days, increased cough, pain in the chest along the trachea often indicate the development of complications 7 . Attachment of bacteria sometimes leads to the fact that the common cold is complicated by an inflammatory process in the lungs – bacterial pneumonia 7 . Then the malaise can last a week or longer. In any case, a doctor’s consultation and an additional examination are required.

    Infectious and inflammatory diseases

    If a temperature of 37°C persists for a long time (more than 2 weeks), doctors call this condition prolonged subfebrile condition 5 . It most often occurs in people aged 20-40 years, and in women 3 times more often than in men 5 .

    Subfebrile condition, fatigue, body aches, night sweats – signs of chronic infection or inflammation of any organ 8 . For example, these can be sluggish diseases of the middle ear (advanced otitis), gallbladder ( cholecystitis), bones (osteomyelitis), lungs (pneumonia), uterine appendages (adnexitis), kidneys (pyelonephritis), paranasal sinus (sinusitis) 8 .

    Malignant process

    Slight temperature rises repeated during the day and intermittent fever may be the first signs of developing lymphogranulomatosis (tumor of the lymphatic system) 8 . Therefore, such symptoms should not be ignored – it is necessary to consult a doctor for an examination 8 .

    Neuroses

    Neurocirculatory (vegetative-vascular) dystonia can also be accompanied by subfebrile condition. An increase in temperature is provoked by stress, physical fatigue, changes in weather conditions 10 . At the same time, in addition to hyperthermia and sweating, anxiety can be noted, up to a panic attack 10 , unstable pulse rhythm, fluctuations in blood pressure, irritability, tearfulness 17 .

    Hormonal disorders

    A temperature of 37 °C without cold symptoms in women is one of the manifestations of premenstrual syndrome (PMS) 3 . Usually PMS makes itself felt 7-10 days before the next menstruation 3 . Subfebrile condition may be accompanied by bad mood, headache, breast engorgement, bloating and other symptoms 12 . But with the onset of menstruation, they disappear and the condition returns to normal 3.12 .

    Another women’s problem is climacteric syndrome , which is sometimes severe and is accompanied by various disturbances in the functioning of the nervous system and emotional disorders 3 .

    Both with PMS and during menopause, subfebrile condition can be unstable 8 . For example, with repeated thermometry after 30 minutes, the temperature often turns out to be already normal, and after another 15-30 minutes – again elevated 8 .

    In case of hyperthyroidism – increased function of the thyroid gland – prolonged low-grade fever may precede the appearance of other typical symptoms of the disease: palpitations, increased excitability, tremors in the hands, weight loss and protrusion of the eyes 3 .