Febrile Seizures

Overview

A febrile seizure (also called a febrile fit or fever convulsion) is a seizure that happens in a young child who has a fever. A seizure is a sudden burst of unusual electrical activity in the brain that can make the body stiffen, shake or jerk. Febrile seizures are caused by the fever itself, not by the illness behind the fever. They most often happen in children between 6 months and 5 years old, usually last less than 5 minutes, and the child usually recovers fully afterwards.

Yes, they are common. Roughly 1 in 30 children (about 3 to 4 in every 100) will have at least one febrile seizure before their sixth birthday. They are one of the most common reasons parents bring a young child to urgent care.

Febrile seizures affect young children, most often between 6 months and 5 years old, with the peak around 12 to 18 months. They are slightly more common in boys. A child is more likely to have one if a parent or sibling has had febrile seizures, because the tendency can run in families.

Symptoms

Common symptoms

• A fever, often caused by a common infection
• The child becoming stiff, or arms and legs jerking or shaking
• Eyes rolling back or staring blankly
• Not responding to you during the seizure
• Loss of consciousness or going floppy
• Breathing that looks odd, noisy, or brief pauses in breathing
• Skin looking pale or slightly blue around the lips during the seizure
• Being confused, drowsy, clingy or upset for a short time afterwards
• Sometimes wetting themselves during the seizure

Symptoms in children

• A febrile seizure usually happens on the first day of a fever, sometimes before you even realise the child is unwell.
• Simple febrile seizures last less than 15 minutes, involve the whole body, and do not happen again within 24 hours.
• Complex febrile seizures last longer than 15 minutes, affect only one side of the body, or happen more than once in 24 hours. These need medical review.
• After the seizure, many children fall asleep or seem confused for a while, then return to their normal selves.
• Some children have a mild fever or none at all when the seizure happens, because the temperature may have risen quickly and then settled.

Symptoms in older adults

• Febrile seizures are a childhood condition and essentially do not happen in older adults.
• A seizure in an adult is never assumed to be a febrile seizure, even if the person has a fever, and always needs proper medical assessment.
• If an adult has a seizure, treat it as a medical emergency and get help.

Causes

Main causes

• A rapid rise in body temperature, usually from a common childhood infection
• Everyday infections such as colds, ear infections, tonsillitis, chest infections, urine infections, chickenpox, or roseola (a common mild viral illness with a high fever)
• In many cases no specific cause of the fever is found, and the child recovers normally
• Occasionally a febrile seizure happens shortly after a routine vaccination, because vaccinations can cause a mild fever

Risk factors

• Being between 6 months and 5 years old
• A family history of febrile seizures in a parent, brother or sister
• Having had a febrile seizure before, which makes another one more likely
• Being in group childcare, which means more exposure to childhood infections
• Some children who have delays in their development may have a slightly higher chance, but most children with febrile seizures develop completely normally

When to see a doctor

See a doctor urgently if:

• Your child has had their first seizure, even if it has stopped and they seem fine
• The seizure lasted more than a few minutes, or you are not sure how long it lasted
• Your child has another seizure during the same illness
• Your child is under 12 months old and has a fever with a seizure
• Your child seems very drowsy, floppy, difficult to wake, or is not drinking
• Your child has a stiff neck, a rash that does not fade under pressure, or is very unwell
• Your child has a febrile seizure and has a long-term condition or weakened immune system

Book a routine appointment if:

• After a febrile seizure, to check the cause of the fever and make sure your child has recovered
• To talk through what happened and what to do if it happens again
• If your child has had more than one febrile seizure, to plan what support you might need
• If you feel anxious or unsure about caring for your child when they have a fever
• If your child's development or behaviour worries you at any time

Diagnosis

A doctor usually diagnoses a febrile seizure by hearing your description of what happened, combined with examining your child to find the cause of the fever. There is no single test for a febrile seizure. The important things the doctor will want to know are how long the seizure lasted, what your child did during it, whether they have had one before, and how they are behaving now.

Tests that may be done

• A full examination, including checking temperature, breathing, ears, throat, chest and skin
• A urine test if a urine infection is suspected, especially in younger children
• Blood tests are only sometimes needed, for example if the child seems very unwell
• A lumbar puncture (a test of the fluid around the spine) is only done if there is a real concern about a serious infection such as meningitis
• An EEG (a brain wave test) is not usually needed after a simple febrile seizure
• Brain scans are not routinely needed and are only considered in specific situations

What to expect at your appointment

Most children who have had a simple febrile seizure and who seem well afterwards can be checked over and go home the same day. The doctor will explain what to watch for and when to get help. If your child is very young, seems unwell, or the seizure was unusual, they may be kept in hospital for a while for observation.

Treatment

The main goals are to keep your child safe during the seizure, to find and treat the cause of the fever, and to make your child comfortable. The seizure itself usually stops on its own. Most children need no specific treatment beyond care at home and a follow-up check with their doctor.

Self-care at home

• Stay calm and note the time the seizure starts so you can tell how long it lasts
• Place your child on the floor or a safe soft surface, and move hard or sharp objects away
• Do not hold your child down or try to stop the shaking
• Do not put anything in your child's mouth, including fingers, spoons or liquids, and do not try to give medicine during the seizure
• Once the shaking stops, gently roll your child onto their side into the recovery position to keep their airway clear
• Loosen tight clothing and keep them warm but not overheated
• Do not put your child in a cold bath or sponge them with cold water to bring the fever down
• Offer plenty of fluids during the illness to keep them hydrated
• Fever-lowering medicine can make a child more comfortable, but it does not prevent febrile seizures; ask your pharmacist or doctor for advice on what is suitable for your child's age
• Keep your child home from nursery or school while they are unwell and feverish, and let carers know what happened

Medical treatments

Treatment focuses on the illness causing the fever. If the doctor finds a bacterial infection such as an ear or urine infection, they may prescribe antibiotics, which are medicines that treat bacterial infections only. Fever-lowering medicines may be suggested to keep your child comfortable, but they do not stop febrile seizures from happening and are not given just to prevent them. For the small number of children who have long or repeated febrile seizures, a doctor may discuss a rescue medicine that can be given during a prolonged seizure; this is decided case by case by a specialist. Your doctor will explain any options clearly and answer your questions.

When is surgery considered?

Surgery is not part of the treatment for febrile seizures.

Living with this condition

Most children with febrile seizures live completely normal lives. They can go to nursery, school, play sports and take part in everything their friends do. There is no need to wrap them in cotton wool or avoid normal activities. It helps to tell regular carers, such as grandparents, childminders or nursery staff, what a febrile seizure looks like and what to do if one happens.

Lifestyle tips

• Keep your child's routine vaccinations up to date, as this reduces the infections that cause fevers
• Learn the first-aid steps for a seizure and keep a simple plan somewhere handy, such as on the fridge
• Have a thermometer at home and know how to check your child's temperature
• During an illness, offer frequent drinks and let your child rest
• Keep a note of any seizures, including date, how long they lasted and what the child was like afterwards, to share with your doctor
• Make sure anyone who cares for your child knows how to reach you and when to call for help

Diet and exercise

No special diet or exercise plan prevents febrile seizures. Children should eat normally, play normally and get plenty of rest. During a feverish illness, the most important thing is to keep your child drinking fluids and to let them rest as much as they need.

Mental health and emotional wellbeing

Watching your child have a seizure is genuinely frightening, and many parents feel shaky, tearful or anxious afterwards. Some parents find they become very worried every time their child has a temperature, or that they check on them repeatedly at night. These feelings are very common and usually settle with time and reassurance. If worry is affecting your sleep, mood or daily life, talk to your doctor or health visitor. You do not have to cope alone, and support is available.

Prevention

Febrile seizures cannot be reliably prevented. Giving fever-lowering medicine when a child has a temperature does not stop febrile seizures from happening, so it is not recommended for that purpose. The most helpful approach is to reduce the chance of the infections that cause fevers by keeping vaccinations up to date, and to be prepared so you know what to do if a seizure happens.

Vaccines

Staying up to date with your child's routine vaccinations is one of the best ways to prevent the infections that cause fevers. Occasionally a child may have a febrile seizure shortly after a vaccination because of the mild fever it can cause. This is rare, and the protection vaccines give is far greater than this small risk. If your child has had a febrile seizure after a vaccine, talk to your doctor before the next one rather than deciding to skip it.

Screening programmes

There is no screening test for febrile seizures. They are recognised from what happens during the seizure, not by testing in advance.

Complications

If left untreated

• Most febrile seizures stop by themselves and cause no lasting problems
• There is a small risk of injury during a seizure, which is why it helps to clear the area and place the child safely
• There is a small risk of breathing in vomit or saliva, which is why the recovery position matters once the shaking stops
• Very rarely, a seizure lasts a long time (called status epilepticus), which is a medical emergency
• About 1 in 3 children will have another febrile seizure, usually in the following year or two
• A small number of children go on to develop epilepsy (a tendency to have seizures without fever); this is uncommon, and most children with febrile seizures do not

Long-term outlook

The outlook is very good. Simple febrile seizures do not cause brain damage, learning difficulties or behaviour problems, and most children grow out of them by around age 5 or 6. Your child should be able to do everything other children do. If you have any worries about your child's development or about future seizures, your doctor can talk them through with you.

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