Febrile Seizures
Description Diagnostic criteria General and supportive measures Medicine treatment Referral R56.0 DESCRIPTION Febrile seizures occur between the ages of 6 months and 6 years of age in association with a significant fever (>38.5°C) in the absence of an intracranial infection and are typically associated with viral upper respiratory tract infections. These are the most common type of seizures in
General and supportive measures
R56.0
DESCRIPTION
Febrile seizures occur between the ages of 6 months and 6 years of age in association with a significant fever (>38.5°C) in the absence of an intracranial infection and are typically associated with viral upper respiratory tract infections. These are the most common type of seizures in children of this age, however, diagnosis requires the exclusion of other causes of seizures.
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Febrile convulsions can be simple or complex.
Simple febrile seizures:
- are generalised,
- occur once per illness,
- last less than 15 minutes (typically 1–2 minutes),
- are not associated with any neurological deficit,
- are self-limiting,
- consist of only one seizure during the febrile illness which needs no specific treatment, and
- may be associated with a family history of simple febrile seizures.
Complex febrile seizures have one or more of the following characteristics:
- Seizure duration of 15 minutes or more;
OR - are recurrent within the same febrile illness;
AND/OR - have a focal onset.
AND/OR - are associated with post-ictal, focal neurological abnormalities.
Children with febrile seizures have a good prognosis, and very rarely develop epilepsy.
The overall risk for recurrence of simple febrile seizures is 30 - 40%. Factors which increase the risk for recurrent febrile seizures include:
- seizure disorder in a first-degree relative,
- onset before 12 months of age,
- initial complex seizures.
DIAGNOSTIC CRITERIA
Clinical
- Investigate for intracranial, extracranial, and biochemical causes of fever or seizure.
- Signs of meningism are unreliable in children less than 18 months of age.
- If raised intracranial pressure or meningitis cannot be excluded, the diagnosis of febrile seizures cannot be made. Treat children empirically for meningitis if suspected.
Investigations
Lumbar puncture
- Lumbar puncture is indicated in:
− All children with clinical features of meningitis. - Lumbar puncture may be indicated in:
− Children where meningitis cannot be excluded, e.g. <18 months of age or those who have received antibiotics prior to the event. - No further investigation is required in children ≥18 months of age where a focus of extracranial infection is present, and intracranial infection such as meningitis has been excluded clinically.
Neuroimaging
- Children with complex febrile seizures and/or persistent lethargy may require neuroimaging, followed by a lumbar puncture if raised intracranial pressure can reliably be excluded based on clinical assessment (see Lumbar puncture).
- Based on clinical findings, investigate complex febrile seizures for possible underlying conditions such as meningitis, focal brain lesions and epilepsy.
Note:
An EEG is of no value in simple febrile seizures but may be considered in recurrent complex febrile seizures.
GENERAL AND SUPPORTIVE MEASURES
- Reassure parents and caregivers.
- Educate parents and caregivers regarding the first aid management of seizures.
- Counsel against tepid sponging and fans as this increases the core temperature.
- Counsel that recurrent febrile seizures occur in 30-40% of patients.
- Look for a cause of the fever.
- Always exclude meningitis (See Meningitis, acute bacterial).
MEDICINE TREATMENT
For fever related symptoms (temperature > 38.5˚C):
- Paracetamol, oral, 15 mg/kg/dose 6 hourly.
Note:
Paracetamol has no effect on seizure prevention.
For convulsions lasting 5 minutes or longer, see Status epilepticus.
Continuous antiseizure medication prophylactic therapy.
- Routine daily antiseizure medication prophylaxis is not recommended for patients with simple febrile seizures.
- For children with recurrent complex febrile seizures, discuss the treatment options with a specialist.
REFERRAL
- All patients with recurrent complex febrile seizures without an obvious cause of the seizure and/or not responding to initial management should be discussed with a specialist.
- Developmental delay/regression.
Click here to access NEMLC Report.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Paediatric Hospital Level_Updated May 2025
Chapter 13: The Nervous System_13.3 Febrile Seizures