What Causes Fluctuating Fever in Toddler? 

A fever in a toddler can signal an infection or illness, and a fluctuating one may mean something more serious. Fevers are a normal part of the body trying to fight something, and they usually go away once they are better. If your toddler is having fevers that fluctuate or come and go, it is probably a good idea to get things checked out. This article will help you understand some of the causes of this, other signs to watch for, and some helpful tips to help your baby feel more comfortable.

Is It Serious? What Causes It?

Yes and no. It really depends on the cause. In some toddlers, the body temperature may go up and down with teething. However, teething never causes a fever to “spike” over 100.4. It may also be a non-specific virus your little one is trying to fight off. In other cases, something else may be going on. The causes include:

1.     Urinary Tract Infection

Urinary tract infections can cause fluctuating fever in toddlers. These can be sneaky and tricky to diagnose. Your toddler may not be talking well and cannot tell you that it “burns when they pee.” The pediatrician may have ruled out any other infections, but see no signs of any other illness. You may just notice fevers that go up and down. In this case, your child’s doctor may check a urine sample.

2.     PFAPA Syndrome

PFAPA Syndrome (periodic fever adenitis pharyngitis) is an immune syndrome that causes fluctuating fevers, and sometimes very high fevers. There are usually no other signs of contagious illness, and the child has not been around anyone who is sick. They do show some signs like swollen glands and mouth ulcers. These fevers show up around every 3 weeks or so for around 3 to 5 days and then go away on their own. The child will seem very sick during the fevers and complain of pain. It is usually outgrown by the time the child reaches adulthood. Researchers have not yet found a cause for this condition and children grow and develop the same as other kids with no lasting effects.

3.     Rat Bite Fever

RBF (Rat bite fever) is caused by a bite from a rodent infected with Streptobacillus moniliformis, a common bacteria in rats in North America. It can also be acquired by eating or drinking food contaminated with the bacteria by rats. Rats, gerbils, and mice can all carry this bacteria. It can even be spread by handling the animal, or being scratched by them. Fevers begin spiking between 3 and 10 days after contact. There may be a rash with the fever, vomiting, and severe headache. This can be fatal if left untreated.

4.     Cyclic Neutropenia

This is an immune system disorder that causes episodes of fevers and infectious illness due to a weakened immune system. Blood tests show a low neutrophil count that occurs about every 3 weeks. It usually appears in infancy and peaks around the toddler years. It is caused by a mutation in the ELANE gene, but children do tend to outgrow the frequent fevers and illness when they reach adulthood. The condition can be managed by giving immunoglobulin treatments to boost the immune system.

5.     Hodgkin’s Disease

This is a type of cancer that affects the lymphatic system, lymphoma. Hodgkin’s disease attacks the immune system in the area of the lymph nodes. While one of the first symptoms is a swollen gland or lump, it can also cause fluctuating fever in toddlers with chills. It is actually rare in small children, but can occur if there is a family history of Lymphoma. You may notice your toddler have a lack of appetite, night sweats, and generally feel unwell. The fevers may come and go with fluctuations in temperature. This is a highly treatable cancer if caught early.

6.     Leukemia

Rarely, a child with chronic fluctuating fevers may be showing signs of leukemia. This is a cancer of the bone marrow that causes abnormal white blood cells to form. These white blood cells have reduced ability to fight off infections. It presents with symptoms like high fevers, chills, profound weakness, fatigue, chronic infections, pain in the bones, and nosebleeds.

7.     Malaria

While Malaria is rare, it can be acquired if you travel out of the country. It is passed on from a mosquito bite, and can be life threatening. There have been no cases of malaria acquired in the United States since the 1950s, but people who travel abroad can catch it. Uncomplicated malaria may show up as fever and chills that last from 6 to 10 hours, then goes away for a few days, then comes back. Your toddler may have a fluctuating fever and flu-like symptoms. In severe cases, your child may lose consciousness or be very hard to awaken. If you have traveled outside of the country, these symptoms need medical attention!

Other Signs That Usually Accompany with It

  • Inconsolable crying
  • Swollen glands
  • Frequent wet diapers
  • Very few wet diapers
  • Excessive sleepiness
  • Refusal of food
  • Not playing as usual
  • Frequent illnesses with recurrent fluctuating fever (colds, flu, stomach viruses)
  • Rashes
  • Signs of dehydration (Dry eyes, dry mouth, lack of tears when crying, fewer wet diapers)

How to Help Your Baby

A fluctuating fever can make your baby very uncomfortable and cranky. Whether your child is being treated for illness or not, you can take steps at home to make him or her comfortable. Here are some helpful tips:

  • Encourage Plenty of Fluids. Make sure your child drinks plenty of fluids like electrolyte replacement, diluted juices, jello, and broth during fevers. This will help avoid dehydration.
  • Offer Sugar-Free Ice Pops. Offer cool foods like sugar-free ice pops.
  • Give Soft Foods. During a fever, your child may only want to eat soft foods. Try; applesauce, pudding, jello, and soups.
  • Undress and Cover with Light Sheet. Don’t bundle your child up if they have chills. This can drive fevers up. Instead, use a light sheet and dress them in light clothing.
  • Try a Tepid Bath. A lukewarm bath can help bring the temp down and make your child more comfortable. Just use tepid water without anything added.

When to See a Doctor

If your toddler has a fever over 100.4, it is a good idea to give your pediatrician a call. If the fluctuating fever in toddler lasts more than 3 days, your child may need to be seen in the office. If fluctuating fevers tend to recur chronically in a pattern, your child may need further testing to find the cause.