UAE doctors warn parents: Recurrent fevers in children could signal serious illnesses

Dubai: When two-year-old Lia was brought to the emergency department with a soaring temperature of 40°C, her Jordanian parents assumed it was a common viral infection. But with no signs of cough, cold, or flu and a worrying pattern of fever episodes returning every few weeks, doctors knew they had to look deeper.

“When a child has repeated episodes of fever and seems completely fine in between, it’s time to consult a pediatrician,” said Dr Danny Al Salloum, Consultant Paediatrician at Medcare Women and Children Hospital, who treated Lia.

Lia had no history of serious illnesses. Her vaccinations were up to date, and her developmental milestones were normal. But she had additional symptoms such as abdominal discomfort, nausea and poor oral intake, without any respiratory, dermatological or joint-related manifestations.

A detailed examination revealed enlarged and inflamed tonsils and cervical lymphadenopathy on the left side.

Her case, while not uncommon, is a timely reminder for UAE parents to pay closer attention when fever keeps coming back in children, especially in the absence of typical cold or flu symptoms.

Recurrent fever is generally defined as three or more unexplained fever episodes in six months, with at least one occurring within the past six weeks. In some children, the episodes follow a predictable cycle, returning every three to six weeks.

A pattern of similar symptoms with each fever episode may indicate PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) or Familial Mediterranean Fever (FMF).

“We see many children in the UAE who attend nursery or daycare early, so frequent fevers are expected. But if the pattern is regular, severe, and not linked to exposure to a sick person, it raises concern,” said Dr Al Salloum.

Dr Al Salloum advises parents to look beyond the number on the thermometer. Red flags that may signal a more serious immune-related condition include:

Fever lasting more than 3–5 days

High-grade fevers (>38.5°C) that resolve spontaneously

Similar symptoms during each episode, such as:

Mouth ulcers

Sore throat

Swollen lymph nodes

Tummy pain or joint aches

No cold, cough, or flu symptoms

Child appearing well between episodes

“Parents shouldn’t panic at every fever. But if you see a pattern, don’t ignore it. Early diagnosis of periodic fever syndromes can make all the difference in managing symptoms and improving quality of life,” said Dr Al Salloum.

Dr Adel Waheeb Jasim, Consultant Paediatrician at Burjeel By The Beach Clinic, Saadiyat Island, echoed the same.

"Common fevers are usually linked to viral infections, last two to three days, and occur sporadically. If fevers recur regularly without clear cause, or are accompanied by similar symptoms each time, this may suggest a periodic fever syndrome," he said.

“If fevers occur at regular intervals and come with the same symptoms like mouth ulcers or swollen glands, it may point to a condition like PFAPA or FMF."

Conditions like PFAPA usually begin before age five and follow a predictable pattern, he explained.

While most viral fevers are short-lived and sporadic, recurrent fevers often require deeper investigation, including blood tests and immune screenings.

“A child who experiences more than three such episodes in six months, especially with poor recovery or growth delays, should be evaluated by a specialist. Blood tests and inflammatory markers may be needed for diagnosis,” Dr Jasim added.

While not all fevers are avoidable, especially in communal settings like nurseries, doctors recommend the following steps to boost a child’s immunity and reduce risk:

Encourage regular handwashing

Keep up with routine vaccinations, including flu and pneumococcal

Offer a balanced diet rich in fruits, vegetables, and iron

Ensure adequate sleep and hydration

Avoid sending sick children to school or nursery

Teach respiratory hygiene (e.g., coughing into elbows)

Limit time in crowded indoor spaces during peak illness seasons

Doctors caution that unexplained recurrent fevers in adults also could signal underlying serious health conditions.

In one such case from the UAE, a 40-year-old male patient presented with persistent throat discomfort, myalgia, weakness and recurrent low-grade fevers for several weeks. During this period, he consulted multiple doctors and was prescribed antibiotics twice, under the assumption that it was a routine bacterial infection. However, there was no improvement.

Upon further evaluation by a specialist in Al Shahama in Abu Dhabi, cervical lymphadenopathy (swollen lymph nodes in the neck) was detected, although the tonsils appeared normal.

"Given the lack of response to antibiotics and the prolonged nature of symptoms, a viral infection was suspected. Subsequent screening confirmed the presence of Epstein-Barr Virus (EBV), a common viral infection often overlooked in primary assessments," said Dr Jobran Habeeb Al Salman, the internal medicine specialist who treated the patient.

Since EBV has no specific antiviral treatment, he said, the patient was managed symptomatically with rest and analgesics, and he eventually recovered without complications.

While this patient recovered well, medical experts caution that such symptoms can sometimes mask more serious underlying conditions, including tuberculosis, autoimmune disorders like lupus, or even certain cancers. Hence, a timely and thorough clinical evaluation is crucial when fevers persist or recur despite initial treatment.