Febrile Seizures

Presentation

• Occur in children aged 6 months to 6 years

• Triggered by fever above 38°C, often during a viral illness

• Simple febrile seizures are generalised tonic-clonic, last under 15 minutes, and do not recur in 24 hours

• Complex febrile seizures may be focal, last over 15 minutes, or recur in the same illness

• Recurrence risk is about 50% by 1 year of the first episode if onset is early

• Antipyretics do not reliably prevent further febrile seizures in the same illness

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When To Refer

• Urgent (Emergency Department)

  • Seizure lasting more than 10 minutes

  • Focal features, prolonged limb weakness, or postictal confusion

  • Recovery taking over 1 hour

  • Multiple seizures during the same febrile illness

• Elective (Non-Urgent)

  • Abnormal neurological examination or concerns about developmental delay

  • Recurrent complex febrile seizures

  • Family history of epilepsy or early onset under 12 months

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Epilepsy Risk Factors

• Family history of epilepsy

• Complex febrile seizures (focal or prolonged)

• Neurological deficits or significant developmental concerns

• Very early onset (under 12 months)

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Management

• During Seizure

  • Do not restrain and avoid placing objects in the mouth

  • Position the child on the side (recovery position) to prevent aspiration

  • Keep the child safe by moving nearby objects

• Post-Seizure

  • Call an ambulance if the seizure exceeds 5 minutes, repeats, or if consciousness is not regained

  • Treat fever for comfort using paracetamol or ibuprofen, though this does not prevent recurrence

  • Record details in a seizure diary

• Additional Considerations

  • Investigations not routinely needed for simple febrile seizures unless signs suggest bacterial infection, focal seizure, or meningitis

  • No role for ongoing prophylaxis with antiepileptic drugs in typical simple febrile seizures

  • Vaccination schedules remain unchanged, though discuss timing of MMRV if febrile seizures are a concern

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Parent Education

• Explain that febrile seizures are generally benign and have a low risk of progressing to epilepsy when simple

• Emphasise correct first aid steps during a seizure and signs requiring urgent medical review

• Encourage families to maintain a seizure diary to document episodes and triggers