Febrile seizure

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  • 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 


    • 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%)


    Simple Febrile Seizure Complex Febrile Seizure Afebrile Febrile Seizure
    Fever and all of the following:
    • generalised tonic-clonic seizure
    • duration of less than 15 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 15 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% 


    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  



    • 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  


    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

  • Reference List

    1. Lee WL, Ong HT. Afebrile seizures associated with minor infections: comparison with febrile seizures and unprovoked seizures. Pediatr Neurol. 2004;31(3):157-164.
    2. Mewasingh, L et al. Febrile Seizure. Retrieved from https://bestpractice.bmj.com/topics/en-gb/566 (viewed 13 May 2019)
    3. Millichap, JJ et al. Clinical features and evaluation of febrile seizures. Retrieved from https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures?search=febrile%20seizure&source=search_result&selectedTitle=1~134&usage_type=default&display_rank=1 (viewed 15 May 2019)
    4. Millichap, JJ et al. Treatment and prognosis of febrile seizures. Retrieved from https://www.uptodate.com/contents/treatment-and-prognosis-of-febrile-seizures?search=febrile%20seizure&source=search_result&selectedTitle=2~134&usage_type=default&display_rank=2 (viewed 15 May 2019)
    5. Paediatric Epilepsy Network. Febrile seizures. Retrieved fromhttp://www.pennsw.com.au/clinicians/syndromes/febrile-seizures (viewed May 13 2019)
    6. Patel, N et al. Febrile Seizures. BMJ. 2015. 351:h4240 [DOI: https://doi.org/10.1136/bmj.h4240, viewed May 2019]