PFAPA in children: how to track the fever episodes

What PFAPA is

PFAPA stands for Periodic Fever, Aphthous stomatitis (mouth ulcers), Pharyngitis (sore throat) and cervical Adenitis (swollen glands in the neck). It is the most common of the periodic fever syndromes in children and usually begins in early childhood, often before the age of five.

The typical picture is a child who gets a high fever that lasts a few days, comes with some combination of those three symptoms, and then goes away completely — only to return a few weeks later, on what can feel like a timetable. Between episodes, the child is well, eating normally and growing normally.

Not every child has all three of the extra symptoms, and not every episode looks the same. That variation is one reason the diagnosis can take time, and why a written record is so valuable.

Why tracking matters so much with PFAPA

There is no blood test that says "this is PFAPA". Doctors usually reach the diagnosis by looking at the pattern of episodes and ruling out other explanations. That puts the parent in an unusual position: the most important evidence is something only you have seen.

Memory is a poor tool for this. After three or four episodes the dates blur together, it becomes hard to say whether the last one was five weeks ago or seven, and you can't remember whether there were mouth ulcers in March. A simple, consistent record solves that.

What to record in each episode

During the fever

• Start date and time — the first reading at or above 38°C (100.4°F) is a sensible marker. Use the same rule every time so the gaps are comparable.
• Temperature readings — a few a day is plenty, with the time and how it was measured (ear, forehead, armpit, mouth). Note the peak.
• Symptoms — mouth ulcers, sore throat, swollen or tender neck glands, plus anything else: tummy ache, headache, tiredness, chills.
• Medicines — what you gave, the dose and the time. This also stops anyone in the house from doubling up at 3am.
• How your child seems — a word or two is enough: "flat, not eating", "playing between doses".

When it ends

• End date — the first full day without a fever.
• Any doctor visits and what was said, including test results if you were given them.

Between episodes

• A note that your child was well is surprisingly useful. "Completely fine between episodes" is part of the picture doctors look for.
• Anything that might matter: a nursery bug going round, a vaccination, travel.

How to work out your child's cycle

The useful number is the gap from the start of one episode to the start of the next, not from the end. Here's a worked example:

Average the gaps (29, 27 and 29 → about 28 days) and you have a rough cycle length. Add it to the last start date and you get a likely window for the next episode: around 24 June. It won't be exact, but a predicted window lets you think ahead about a holiday, a birthday party, an exam or time off work.

The shortest and longest gaps matter too. A doctor will be interested in how regular the pattern is, and in whether it's changing over time — episodes getting further apart, for instance.

Taking your record to the paediatrician

Appointments are short. A record that can be read in a minute is worth far more than a detailed one that can't. The most useful summary is usually:

1. A list of episodes with start date, length and peak temperature.
2. The average gap between episodes, plus the shortest and longest.
3. Which symptoms appear in most episodes.
4. What medicines you've used and whether they seemed to help.
5. A line confirming your child is well between episodes.

Bring the full detail too, in case the doctor wants to look at a particular episode. Our guide to preparing a symptom diary for the doctor goes into more depth.

Tips that make the record more useful

• Use the same thermometer and method where you can. Readings from different methods aren't directly comparable.
• Log it at the time, not the next morning. Times are the first thing to go.
• Keep one record per child. If a sibling catches a cold, that's a different story and shouldn't muddy the pattern.
• Don't stop when you get a diagnosis. The record remains useful for tracking whether treatment is working and whether episodes are becoming less frequent.

This guide is about keeping a record, not about diagnosis or treatment. A fever with a regular pattern isn't always PFAPA, and only a doctor can tell. If your child seems very unwell, or you're worried, contact a doctor or your local emergency number.