Febrile Convulsions

A simple febrile convulsion is a brief (<15 min) generalized convulsion in a febrile (>38°C) child aged between 6 months and 6 years, with no previous afebrile seizures, no progressive neurological condition and no central nervous system infection. Febrile convulsions are common, and occur in 3% of healthy children between the ages of 6 months and 6 years. They are usually associated with a simple viral infection. The onset of the convulsion may be sudden with little evidence of preceding illness. The convulsion may be terrifying for the parents to observe—they frequently believe that their child is dying and may attempt CPR or other resuscitative measures. Febrile convulsions are benign, with minimal morbidity and essentially no mortality. Most febrile convulsions are brief and do not require any specific treatment. The initial management of the convulsion is described in the afebrile seizure section.

After the convulsion

A septic work-up including lumbar puncture is mandatory in children under 6 months of age; by definition a febrile convulsion should not be diagnosed in a child under 6 months. Lumbar puncture should be very strongly considered in those aged 6–12 months. Possible clinical scenarios and management include those shown in Box 6.2. Most children with simple febrile convulsions who have recovered sufficiently do not need to be admitted to hospital If a patient is discharged home following a febrile convulsion, it is important to give the family advice regarding fever control and what to do in the event of a future convulsion. Verbal advice should be reinforced with written advice. Follow up during the next 24 hours is advisable to assess the progress of the child’s illness and to allow parents the opportunity for further discussion.

Possible clinical scenarios and management following febrile convulsions

Repeated convulsions during the same illness occur in about 10–15% of children. The child should be reassessed in hospital. There are usually no serious implications; however, a period of observation might be required to clarify the progress of the illness.

Fever control

Clothing should be minimal—a nappy alone or light outer layer depending on ambient temperature. Tepid sponging, baths and fans are ineffective in lowering core temperature, and are not recommended. Paracetamol has not been shown to reduce the risk of further febrile convulsions. It may be used for pain or discomfort or as an antipyretic associated with febrile illnesses such as otitis media. The parents should understand the reasons for its use and be discouraged from trying to get their child’s fever down.

Long-term issues

Recurrence rate depends on the age of the child—the younger the child at the time of the initial convulsion, the greater the risk of a further febrile convulsion. Epilepsy. Risk of future afebrile convulsions is increased by a family history of epilepsy, any neurodevelopmental problem or complex, very prolonged or focal febrile convulsions. 

Risk of afebrile convulsions following a febrile convulsion

• No risk factors: 1% risk of future epilepsy, similar to the general population

• 1 risk factor: 2% increased risk

• More than 1 risk factor: 10% increased risk

Anticonvulsant treatment. Children who have recurrent prolonged convulsions (which are rare) may benefit from having a rectal diazepam kit available at home, which their parents can administer if a convulsion does not cease spontaneously within 5 minutes. Long-term anticonvulsants are not indicated except in rare situations with frequent recurrences. It may be appropriate to offer a review appointment with a general pediatrician.