Fever Febrile Convulsions

Overview

A febrile convulsion (say: FEB-rile kon-VUL-shun), also called a febrile seizure, is a fit or seizure that happens when a young child has a fever. During the seizure the child may go stiff, shake, twitch, or lose awareness for a short time. It is caused by the fever itself, not by the specific germ behind the fever. A febrile convulsion is not epilepsy (a condition that causes repeated seizures without a clear trigger). Most febrile convulsions last less than five minutes and stop on their own.

Yes, febrile convulsions are common. They are one of the most frequent reasons parents bring a young child to a doctor or emergency department. Most children who have one are completely back to normal within an hour or so.

They happen mainly in children between 6 months and about 5 years old, and are slightly more common in boys. Some families have more of them, which suggests that genes play a part. Febrile convulsions do not happen in older children or adults — a seizure with a fever in an older child or an adult is not a febrile convulsion and needs urgent medical assessment.

Symptoms

Common symptoms

• A fever, often above 38°C (100.4°F), which may come on quickly
• The child goes stiff, or their arms and legs twitch or shake
• The eyes may roll back, stare, or look to one side
• The child does not respond to you or to their name
• Sometimes loss of bladder or bowel control
• Pale or slightly blue lips during the seizure
• Sleepiness, confusion, or clinginess for a short time afterwards

Symptoms in children

• A 'simple' febrile convulsion lasts less than 15 minutes, involves the whole body, and happens only once in a 24-hour period. This is the most common type.
• A 'complex' febrile convulsion lasts longer than 15 minutes, affects only one side of the body, or happens more than once in 24 hours. These need to be checked by a doctor.
• After the seizure, many children fall asleep or seem dazed for 10 to 30 minutes before returning to their usual selves.
• Some children have a febrile convulsion before anyone has noticed the fever at all.

Symptoms in older adults

• Febrile convulsions only happen in young children, because a growing brain seems more sensitive to fever.
• A seizure with a fever in an older child, teenager, or adult is not a febrile convulsion and should be assessed urgently the same day.
• In adults, a seizure with fever can be a sign of a serious infection such as meningitis, so call emergency services if there is confusion, a stiff neck, severe headache, or a rash that does not fade when pressed.

Causes

Main causes

• Any illness that causes a fever can trigger a febrile convulsion. Viral infections such as colds, flu, and tummy bugs are the most common.
• Bacterial infections such as ear infections, throat infections, or chest infections can also be the cause.
• Occasionally a fever after a routine vaccination is followed by a febrile convulsion.
• The trigger seems to be the rise in body temperature itself, which is why the same child may have a seizure with one illness and not another.

Risk factors

• Being between 6 months and 5 years old
• A family history of febrile convulsions in parents or siblings
• Having a first febrile convulsion before 18 months of age
• A fever that rises quickly
• Certain conditions that affect brain development, or being born prematurely
• Attending daycare, which simply means more childhood infections and therefore more fevers

When to see a doctor

See a doctor urgently if:

• Your child has a seizure for the first time — get medical advice the same day even if they seem fine afterwards
• A seizure lasts more than 5 minutes — call emergency services
• Your child is under 6 months old with any fever
• Your child has a seizure affecting one side only, or is weak down one side afterwards
• Your child is very sleepy, floppy, or hard to wake
• Your child has a rash that does not fade when pressed, a stiff neck, or is bothered by light
• Your child is not drinking, or has not passed urine for 8 hours or more

Book a routine appointment if:

• Your child has had febrile convulsions before, has recovered quickly, and you want advice about what to do next time
• You would like a written plan for school, nursery, or other carers
• The fever has lasted more than 5 days
• You feel anxious about the next fever and want to talk it through
• Your child seems to be having fevers more often than usual

Diagnosis

A doctor can usually tell that it was a febrile convulsion by listening to what you saw and checking your child carefully. The most important job is to find the cause of the fever, because that is what needs treating. There is no special test for febrile convulsions themselves.

Tests that may be done

• Checking temperature, breathing, heart rate, and oxygen level
• A full examination, including the ears, throat, chest, tummy, and skin
• Sometimes a urine sample to look for a urine infection, especially in younger children
• Sometimes blood tests or a chest X-ray if a more serious infection is suspected
• Rarely, tests such as a brain scan or brain wave test (EEG), usually only if the seizures were complex or keep happening without fever

What to expect at your appointment

Most children can be checked quickly and go home the same day with advice. If your child is very young, the seizure was long, or the cause of the fever is not clear, the doctor may suggest a short stay for observation. Bring any notes you made about the seizure — how long it lasted, what it looked like, and how your child was afterwards. That information is genuinely helpful.

Treatment

The main aims are to keep your child safe if another seizure happens, keep them comfortable, and treat the illness causing the fever if treatment is needed. The convulsion itself usually needs no treatment because it stops on its own. Medicine given every day to prevent febrile convulsions is not normally recommended, because for most children the risks outweigh the benefits.

Self-care at home

• Stay calm and time the seizure — note when it started and what your child's body is doing
• Lay your child on their side on something soft and clear hard or sharp objects away
• Do not put anything in their mouth, and do not hold them down
• Do not put them in a bath during or straight after a seizure
• Once the seizure has stopped, keep them cool with light clothing and a room at a comfortable temperature
• Offer plenty of fluids in small, frequent sips — breast milk, formula, or water
• Do not sponge with cold water; it is uncomfortable and does not help
• If your child is uncomfortable with fever, ask your pharmacist which fever medicine is suitable for your child's age and weight, and follow the label carefully
• Write down what happened so you can tell a doctor, and tell anyone else caring for your child what to watch for

Medical treatments

If a seizure does not stop within about 5 minutes, emergency staff may give medicine to stop it — usually through the nose, into a vein, or into the bottom. This is why timing matters. Doctors will also look for and treat the illness behind the fever. For example, some bacterial infections need antibiotics. Daily preventive medicine for febrile convulsions is only considered in rare situations, after specialist discussion, because the possible side effects usually outweigh the small benefit for most children.

When is surgery considered?

Surgery is not used to treat febrile convulsions.

Living with this condition

After a febrile convulsion, most children are back to their usual selves within an hour or so. You can treat fevers at home as you normally would. It helps to have a simple plan in your head — or on the fridge — for what to do if it happens again. Tell nursery, school, childminders, and grandparents what to watch for and what to do, so everyone feels prepared.

Lifestyle tips

• Keep a thermometer at home so you can check temperatures confidently
• Write a short seizure action plan and share it with everyone who cares for your child
• Keep your child's routine vaccinations up to date
• Make sure carers know to time a seizure and to call emergency services if it lasts more than 5 minutes
• Keep your child's fingernails short and their sleeping area clear of hard objects

Diet and exercise

No special diet or exercise plan is needed. During a fever, encourage rest and plenty of fluids. Once your child is well again, normal play, running about, swimming, and sport are all fine. Having a febrile convulsion does not mean your child needs to avoid activity.

Mental health and emotional wellbeing

Watching your child have a seizure is very upsetting, and many parents feel shaken, tearful, or on edge for weeks afterwards. It is normal to feel anxious every time your child gets a temperature. Some parents find it hard to sleep or feel guilty, even though nothing could have been done to prevent it. If worry is affecting your sleep, mood, or daily life, please tell your doctor or health visitor — support is available, and you do not have to cope alone.

Prevention

You cannot fully prevent febrile convulsions, because they happen alongside the ordinary fevers of childhood. Giving fever medicine does not reliably stop a seizure from happening, so it is not recommended just for that reason. What you can do is be prepared: know what to do during a seizure, keep your child's vaccinations up to date, and get medical advice as recommended.

Vaccines

Keep your child up to date with their routine childhood vaccinations. These protect against serious infections that can cause high fevers. A mild fever can follow a vaccination, and on rare occasions a febrile convulsion can happen afterwards, but the protection offered by vaccines is far greater than this small risk. Ask your nurse or doctor if you have questions.

Screening programmes

There is no screening test that can predict which children will have febrile convulsions. Nothing your child did or did not do caused this.

Complications

If left untreated

• Most febrile convulsions stop by themselves within a few minutes and cause no lasting problems at all.
• Very rarely, a seizure that lasts a long time, or several seizures in a row, can be harmful and needs emergency treatment — this is why timing and calling for help matter.
• Injury from falling during a seizure is a real risk, so keeping the area safe is important.
• A small number of children who have complex or repeated febrile convulsions have a slightly higher chance of epilepsy later in life. Most children do not.
• Parents often worry about brain damage — short febrile convulsions are not linked to brain damage or learning difficulties.

Long-term outlook

The outlook is very good. Most children outgrow febrile convulsions by around age 5 or 6 and never have another one. They do not cause lasting harm to the brain, and children who have had them do just as well at school as other children. Your child can live a full, normal, active life.

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