Health condition
PFAPA syndrome
PFAPA - periodic fever with aphthous ulcers, pharyngitis and adenitis - is the commonest periodic fever syndrome of childhood: dramatic clockwork fevers in a completely well child, benign in the long run and remarkably responsive to a single steroid dose.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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The pattern: high fevers lasting 3-6 days, recurring every 3-6 weeks with striking regularity, with mouth ulcers, sore throat and tender neck glands - and complete health in between
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Attacks look identical each time and are not true infections - antibiotics make no difference
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A single dose of prednisolone at attack onset typically aborts the episode within hours (though it can shorten the interval to the next one)
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Specialist: a consultant paediatrician or paediatric immunologist; PFAPA causes no long-term harm and nearly always resolves by adolescence - tonsillectomy is an option for severely affected children
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
PFAPA announces itself with a rhythm parents can practically diary in advance: every few weeks a sudden high fever, red throat, mouth ulcers and swollen neck glands, four or five days of misery, then a return to complete normality - normal growth, normal energy, normal everything - until the next round. Throat swabs are negative, antibiotics do nothing, and the child is conspicuously well between attacks. It is an auto-inflammatory condition - a periodically overenthusiastic innate immune system - not an infection or an immune deficiency.
Diagnosis and treatment routes
Diagnosis is clinical, resting on the characteristic pattern with onset typically before age five, supported by bloods showing inflammation during attacks that settles fully between them, and by excluding mimics such as cyclic neutropenia. Management is refreshingly effective: a single dose of prednisolone at the first sign of fever usually terminates the attack within hours, though families should know the trade-off that intervals between attacks sometimes shorten; colchicine can help frequent attackers, and tonsillectomy has a high cure rate for families who choose it. Above all, PFAPA is benign - it fades away in almost all children by their teens, leaving no trace. In many parts of the UK, routine NHS referrals for this kind of problem currently take 20-45+ weeks, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant paediatrician or paediatric immunologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about PFAPA syndrome.
Quick, plain-English answers to what people ask us most.
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What is PFAPA syndrome?
PFAPA stands for Periodic Fever, Aphthous stomatitis, Pharyngitis, and Adenitis, a condition causing recurrent episodes of fever with mouth ulcers, sore throat, and swollen glands, most common in young children.
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What causes PFAPA syndrome?
The precise cause remains unclear, but it's believed to involve temporary overactivation of the body's innate immune response, triggering episodes without any identifiable infection.
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What are the symptoms?
Recurring fever episodes lasting three to six days, occurring roughly every three to eight weeks, along with mouth ulcers, sore throat, and enlarged neck lymph nodes, are the defining features. The child is well between episodes.
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Is PFAPA syndrome dangerous?
No, PFAPA is generally not dangerous and most children outgrow it over time, though the recurrent episodes can disrupt schooling and family life while they're occurring.
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Is PFAPA syndrome genetic?
There may be a mild genetic predisposition in some families, but PFAPA is not considered a classically inherited genetic condition in the way some other periodic fever syndromes are.
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Can PFAPA syndrome be treated or cured?
There's no single cure, but a dose of steroid medication at the onset of an episode can often abort or shorten it, and for children with frequent, disruptive episodes, tonsillectomy has been shown to resolve symptoms in many cases.
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How is PFAPA syndrome diagnosed?
Diagnosis is clinical, based on the characteristic recurring pattern of symptoms and normal wellbeing between episodes, after excluding other causes of recurrent fever through blood tests.
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How long does PFAPA syndrome last?
Most children outgrow PFAPA by their early teenage years, with the frequency and severity of episodes often decreasing gradually over time even before that.
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PFAPA vs regular childhood infections — what's the difference?
Regular childhood infections vary in type and don't follow a predictable pattern, while PFAPA follows a strikingly regular cycle of fever and symptoms, with the child completely well in between, which is a key clue for diagnosis.
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When should I see a specialist, and how quickly can I be seen privately?
See a paediatrician or specialist if your child has a recurring pattern of fever with mouth ulcers and sore throat. Private paediatric specialist assessment is typically available within about two weeks, considerably sooner than routine NHS referral waits.