This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
See also:Convulsions and Febrile Child guidelinesThe approach to febrile convulsions requires dealing with- the convulsion- the illness causing the fever.
Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection.
These are generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness.
These have one or more of the following:
- focal features at onset or during the seizure- Duration of more than 15 minutes- Recurrence within the same febrile illness- Incomplete recovery within 1 hour.
Febrile status epilepticus
This is a febrile convulsion lasting for longer than 30 minutes.
Note:It is now recognised that some children can have a presentation with convulsions and an acute infectious illness (particularly gastroenteritis) without documented fever. This is sometimes referred to as " afebrile febrile convulsions". The management and prognosis is the same as for classical febrile convulsions.
Treat the convulsion when necessary as per Convulsions guidelines.
* Reassurance is important in simple febrile convulsions. The onset of the convulsion may be sudden with little evidence of preceding illness. The convulsion may be terrifying for the parents to observe they frequently believe that their child is dying and may attempt CPR or other resuscitative measures.
In a simple febrile convulsion once the convulsion 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 convulsion unlikely:- previous afebrile seizures- progressive neurological conditions- signs of CNS infection
In a simple febrile convulsion, where the focus of infection can be identified, blood tests and invasive investigations are often NOT indicated.
In a child less than 6 months of age reconsider your diagnosis, especially the possibility of CNS infection (meningitis guideline).Consider LP if the child is less than 12 months and not up to date with immunisations (especially Hib and pneumococcal), if they are clinically unwell, or if they are already on oral antibiotics that may mask meningitis. Discuss these children with a senior clinician. If there is a genuine contraindication then antibiotic cover appropriate for meningitis should be commenced.
- Complex febrile convulsion.- Seizures unable to be controlled.- Child does not return to normal mental state within 1 hour- Child clinically unwell.- Ongoing concern regarding the nature of the febrile illness. (febrile child guideline)
- Respiratory or haemodynamic compromise.- Children requiring care above the level of comfort of the local hospital.
For advice and inter-hospital (including ICU level) transfers ring the Sick Child Hotline: (03) 9345 7007
- Return to normal neurological state following simple febrile convulsion- Serious bacterial infection excluded or adequately treated- Parental education regarding febrile convulsions
If discharging a patient home following a febrile convulsion, it is important to give the family advice regarding what to do in the event of a future convulsion.- Verbal advice should be reinforced with written advice (give Parent Information Sheet - see below).- Follow-up during as appropriate for the underlying illness.
Parent information sheet:
Information Specific to RCH
If admitted, children with a febrile convulsion are usually admitted under the General Paediatric Team.
Discuss with consultant or senior registrar children with complex febrile convulsions or those in whom LP is being considered.
Long term issues with febrile convulsions.
Last updated April 2011
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