See also
Afebrile seizures
Febrile Child
Key Points
- Most febrile seizures are benign and do not require investigations
- Management includes identifying the source of the infection and treating if indicated
- Antipyretics have not been shown to reduce the risk of further febrile seizures
Background
- Usually occur between 6 months and 5 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:
Simple Febrile Seizure |
Complex Febrile Seizure |
Afebrile
Febrile Seizure |
Fever and all of the following:
- generalised tonic-clonic seizure
- duration of less than 10 minutes
- complete recovery within 1 hour
- do not recur within the same febrile illness
|
Fever and any of the following:
- focal features at onset or during the seizure
- duration greater than 10 minutes
- incomplete recovery within 1 hour
- recurrence within the same febrile illness
|
- Seizures in an acute infectious illness (particularly gastroenteritis) without documented fever
- Features consistent with simple febrile seizure
|
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 (see
Febrile child guidelines)
In addition, look for the following risk factors which make simple febrile seizure unlikely:
-
< 6 months of age (consider CNS infection, see meningitis guideline)
- > 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
In a simple febrile seizure, where the focus of infection can be identified clinically, no investigations are indicated
There is no role for EEG in simple or complex febrile seizures
Investigations for the source of fever, including lumbar puncture, should be guided by the nature of the presentation and age of the child. See
Febrile child guideline for indications for investigations
In a prolonged or focal febrile seizure, consider CNS imaging after consultation with a senior doctor
Treatment
Treat the seizure when necessary as per the
Afebrile seizures guideline
Manage the underlying cause of the fever (see
Febrile child guideline)
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
- Children requiring care above the level of comfort of the local hospital
For emergency advice and paediatric or neonatal ICU transfers, call
the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137
650.
Consider discharge when:
- Return to normal neurological state following simple febrile convulsion
- Serious bacterial infection excluded or adequately treated
- Underlying illness managed appropriately
- Parents aware of first aid advice and management of possible subsequent convulsions
Discharge information:
Parent information
Kids Health Info
Febrile seizures
Fever in children
Last update August, 2019