Febrile seizures in children: what to do and what happens next

A febrile seizure is a fit that happens with a fever in a young child. It is frightening to watch, but a simple febrile seizure does not harm the brain, and most children never develop epilepsy. Keep your child safe, time the fit, and get medical help.

What is a febrile seizure?

A febrile seizure is a fit triggered by fever in a child aged about 6 months to 5 years. It happens without an infection of the brain itself and in a child who has never had a fit without fever.¹

It is the commonest type of seizure in childhood.¹ Parents often tell Dr Dutta they thought their child was dying. The eyes rolled up, the body jerked, and the lips went dusky. It may have lasted two minutes. It felt like twenty.

How common are febrile seizures?

They affect 2 to 5 percent of children between 6 months and 5 years of age.¹ So in a school class of 40 children, one or two will have had one.

They are most common between 12 and 18 months of age.² They often run in families. Many parents find out afterwards that an uncle or a grandmother "had fits with fever" as a child.

Why do some children get seizures with fever?

The young brain is more easily tipped into a seizure by fever, and genes play a part too.²

Most febrile seizures happen within 24 hours of the fever starting.² Sometimes the fit is the first sign that the child is ill, before anyone noticed they were hot. The fever usually comes from an ordinary viral illness, a throat or ear infection. It is the fever, not the type of germ, that matters most.

What does a febrile seizure look like?

Your child may go stiff, then twitch, shake or jerk, stop responding to you, and may vomit or wet themselves.³

• The eyes may roll up or stare.
• Breathing may look irregular and the lips may turn blue or grey.
• Most last 2 to 3 minutes, and it is rare for one to last more than 10 minutes.³
• Afterwards, many children are drowsy, cranky or muddled for as long as an hour.³

Shivering with high fever (rigors) can look similar. But a shivering child is awake and can look at you and answer.

What should I do if my child has a fit with fever?

Stay calm, note the time it starts, and keep your child safe until it stops.³

• Check the time. This is the single most useful thing to tell the doctor.
• Protect the head with your hands or something soft.³
• Move away anything hard or sharp nearby.³
• When the jerking stops, turn your child onto their side (recovery position) and check nothing is in the mouth.³
• If someone else is with you, ask them to record a short video on a phone.

Call an ambulance if the fit lasts more than 5 minutes.³

What should I not do during a febrile seizure?

Keep everything out of your child's mouth, and do not try to hold the arms and legs still.³

• No spoon, finger, water or medicine in the mouth. Children do not swallow their tongue. Objects can break teeth or block breathing.
• Do not try to cool your child by undressing them or sponging with cold water during the fit.³
• Do not pour water on the head or put the child in a bath.
• Do not hold a shoe, onion or anything else to the nose. Dr Dutta still sees this in Kolkata. It does nothing.

Does a febrile seizure cause brain damage?

No. A febrile seizure is very unlikely to cause any lasting harm.³

A large UK study followed children born in one week in 1970 up to age 10. Children who had febrile seizures did as well as other children in school, intelligence and behaviour.⁴ This held for children with longer or repeated seizures too.⁴ Dr Dutta tells parents this early, because it is the thing they most need to hear.

What is the difference between a simple and a complex febrile seizure?

A simple febrile seizure affects the whole body, lasts less than 15 minutes, and happens only once in 24 hours.¹

A seizure is called complex if:⁵

• It is focal, meaning it affects only one part or one side of the body.
• It lasts longer than 15 minutes.
• It happens more than once in the same illness.

Complex seizures usually still have a good outcome. But they need a more careful check and closer follow-up.

Does my child need to see a doctor after a febrile seizure?

Yes. Every child who has a first seizure should be checked by a doctor the same day, even if they look well afterwards.³

The main job is to find the cause of the fever.⁶ The doctor will look carefully for an ear, throat, chest or urine infection, and for signs of meningitis (infection of the covering of the brain). Some children stay in hospital for a short time to be watched.³

Does my child need an EEG, CT scan or blood test after a febrile seizure?

Usually not. For a simple febrile seizure, the American Academy of Pediatrics (AAP) says an EEG (brain wave test), brain scan or routine blood tests are not usually needed.⁶

Tests are chosen to find the cause of the fever, such as a urine test. After a complex seizure, your doctor may advise more tests.

Will my child need a lumbar puncture?

Only if there is a concern about meningitis. A lumbar puncture (a needle in the lower back to test spinal fluid) is done when signs suggest it.⁶

The AAP says it is an option for babies aged 6 to 12 months who have missed their Hib or pneumococcal vaccines, or whose vaccine status is unknown.⁶ It is also an option if the child was already on antibiotics, which can hide signs of meningitis.⁶ Bring your child's vaccination card to the hospital.

Will my child have another febrile seizure?

About 1 in 3 children who have one febrile seizure will have another with a later fever.^7,8

The chance is higher when:⁸

• The first seizure happened at a young age.
• A parent or brother or sister had febrile seizures.
• The seizure happened at a fairly low temperature.
• The seizure came very soon after the fever started.

Children with none of these factors have a much lower chance.⁸ Most children grow out of febrile seizures by school age.

Can paracetamol or ibuprofen prevent a febrile seizure?

No. Trials show that fever medicines do not prevent another febrile seizure.^9,10

In a Finnish trial, about 23 percent of children had another seizure, whether they got fever medicine or a dummy medicine.⁹ In children who did have a seizure, the medicine had not even brought the fever down well.⁹ A review of three trials found the same.¹⁰

So use paracetamol to make your child comfortable, not to chase a number. Do not wake a sleeping child to give syrup. And if your child had a fit while you were giving paracetamol, you did nothing wrong.

Does my child need daily anti-seizure medicine?

Almost never. Regular medicine to prevent febrile seizures is not recommended.²

A Cochrane review found that many of the medicines tried gave no benefit.⁷ Daily phenobarbital, or diazepam given at the start of each fever, did lower the chance of another seizure, but side effects affected up to about a third of children.⁷ Because febrile seizures are harmless in the long run, the reviewers advise good information and first aid training for families instead.⁷ Dr Dutta agrees, and very rarely prescribes them.

What is a rescue medicine for long seizures?

A rescue medicine is a dose given by a parent if a seizure goes on too long. It is only for the few children who keep having febrile seizures.³

The usual choice is midazolam, given into the side of the mouth or nose. In a hospital trial, mouth midazolam stopped seizures more often than diazepam given into the back passage.¹¹ If your doctor prescribes it, they will show you exactly how and when to give it.

Will my child get epilepsy after a febrile seizure?

Very likely not. Febrile seizures are not epilepsy, and the extra risk after a simple one is small.³

In a large US study, about 1 percent of children who were developing normally and had a simple first febrile seizure developed epilepsy by age 7.⁵ That is about twice the rate in children who never had a febrile seizure, but still low, about 1 in 100.⁵ The risk is higher after complex seizures, especially if a child already had a developmental problem.^5,12

When should I call an ambulance or go to emergency?

Call an ambulance or go to the nearest emergency department if:³

• This is your child's first ever seizure.
• The seizure lasts more than 5 minutes.
• Your child has trouble breathing.
• The jerking affects only one side of the body.
• Your child is still unusually drowsy an hour after the fit ends.
• There is more than one seizure within 24 hours.

Also come urgently for a stiff neck, a rash that does not fade when pressed, or a bulging soft spot on a baby's head.¹³ Do not drive while your child is still fitting. Call for help.