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

• 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:

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:

• 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

Kids Health Info

Febrile seizures  
Fever in children
 

Last update August, 2019