Updated September 29, 2026
A child develops a fever, feels miserable for several days, and then returns to their usual self. A few weeks later, it happens again. After several episodes, the family begins looking at the calendar. The pattern can become so predictable that parents feel they know when the next fever will arrive.
That pattern is one of the clues that can lead to a diagnosis of PFAPA.
What does PFAPA mean?
The name describes its characteristic features:
- Periodic fever: repeated episodes of fever.
- Aphthous stomatitis: small, painful mouth ulcers.
- Pharyngitis: an inflamed or sore throat.
- Adenitis: swollen lymph nodes, usually in the neck.
Episodes often last three to seven days and recur every three to six weeks, although the pattern varies. Children generally feel well and grow normally between attacks. American College of Rheumatology: PFAPA
Does every child have all these symptoms?
No—and this is where the name can be misleading.
An international study published in 2014 described 301 patients with PFAPA. Only 132, or about 44%, had all three accompanying features: mouth ulcers, pharyngitis, and swollen lymph nodes. Other symptoms, including abdominal pain and muscle or joint pain, were also reported.
The study illustrates an important point: children with PFAPA do not all look alike. A missing feature does not automatically rule it out, and the acronym alone cannot establish the diagnosis. The 301-patient study
How is PFAPA diagnosed?
There is no single blood test that confirms PFAPA. Clinicians consider the pattern over time, examine the child, and evaluate other possible explanations. Inflammatory markers may rise during an episode, but that finding is not specific to PFAPA.
A rapid response to a prescribed corticosteroid can support the diagnosis, but it does not replace a careful evaluation. If the child remains unwell between episodes, is not growing as expected, or develops a different pattern, the diagnosis deserves another look. ACR patient guidance
What treatments are available?
Treatment depends partly on how much the episodes disrupt the child’s and family’s lives. Options to discuss include:
- Medicines for fever and discomfort, which may make an episode easier to manage.
- A corticosteroid prescribed for an attack, which can stop the fever quickly but does not prevent future episodes. In some children, episodes occur closer together afterward.
- Preventive medicines, such as colchicine or cimetidine, for selected children with frequent or disruptive episodes.
- Tonsillectomy, which may help selected children but requires weighing the potential benefit against the risks of surgery.
These approaches appear in the Childhood Arthritis and Rheumatology Research Alliance’s consensus treatment plans. The plans provide a framework for studying and comparing care; they do not establish one best treatment for every child. CARRA treatment plans
What can families keep track of?
Record fever dates, temperatures, accompanying symptoms, medicines used, and how quickly the child improves. Include missed school and whether the child feels completely well between episodes.
Our Fever and Symptom Diary: Using the AIDAI offers a printable checklist and explains its uses and limitations. A diary helps organize the story; it does not diagnose PFAPA.
PFAPA often improves as children get older, although symptoms can persist into adulthood. In the meantime, predictable fevers can still cause unpredictable disruptions to family life. A clear plan for the next episode can make those days easier to manage. ACR patient guidance