See also       

Afebrile seizures 
Febrile Child    

Key points

1. Most febrile seizures are benign and do not require investigations
2. Management includes identifying the source of the infection and treating if indicated
3. Antipyretics have not been shown to reduce the risk of further febrile seizures 
   

Background

• Seizure in child without previous afebrile seizures, without significant prior neurological abnormality and without signs of CNS infection or metabolic disturbance
  
• Usually occur between 6 months and 6 years of age
• Benign
• Occur in 3% of healthy children
• Normally associated with simple viral infections
• Occur without previous afebrile seizures no significant prior neurological abnormality and no signs of CNS infection
• Recurrence rate depends on the age of the child; the younger the child at the time of the initial seizure, the greater the risk of a further febrile seizure (1 year old 50%; 2 years old 30%)

Classification:

Risk factors for developing subsequent epilepsy include:

• family history of epilepsy
• any neurodevelopmental problem
• prolonged or focal febrile seizures
• febrile status epilepticus

No risk factors: 1% risk of developing epilepsy (similar to population risk)
Risk increases with more risk factors, up to 10% 

Assessment

In a simple febrile seizure, once the seizure has terminated, the aim of the assessment is to determine the cause of the fever 

In addition, look for the following risk factors which make simple febrile seizure unlikely:  

• <6 months of age (consider CNS infection)
• >6 years of age
• any features of a complex febrile seizure
• signs of CNS infection
• previous afebrile seizures 
• progressive neurological conditions 
• developmental delay or regression  
  

Management

Investigations

• No investigations are indicated in a simple febrile seizure, where the focus of infection can be identified clinically and the child returns to baseline mental state
• Investigations for the source of fever, including lumbar puncture, should be guided by the nature of the presentation and age of the child. See fever
• There is no role for EEG in simple febrile seizures and a limited role in complex febrile seizures
• In a prolonged or focal febrile seizure, consider CNS imaging after consultation with a senior doctor  
  

Treatment

Treat the seizure when necessary in the same manner as afebrile seizures 

Manage the underlying cause of the fever

Consider consultation with local paediatric team when

• Seizures unable to be controlled  
• Complex febrile seizure
• Child does not return to normal mental state within 1 hour  
• Child clinically unwell 
• Ongoing concern regarding the nature of the febrile illness
• Frequent seizures (for consideration of anticonvulsants if indicated) 
  

Consider transfer when

• Respiratory or haemodynamic compromise  
• Status epilepticus
• Failure to return to neurological baseline
  
• Children requiring care above the level of comfort of the local hospital  
  

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when

• Return to normal neurological state following simple febrile seizure
• Serious bacterial infection excluded or adequately treated
• Underlying illness managed appropriately
• Parents aware of first aid advice and management of possible subsequent seizures                                     
  

Discharge information:

• Provide verbal and written advice about convulsion management and fever care (give parent information sheet)
• Follow-up as required for the underlying illness
• It may be appropriate to offer a review appointment with a general paediatrician, especially if complex or recurrent febrile convulsions
  

Parent information

Febrile seizures

Fever in children
   

Last update December 2020