Febrile seizures

Key points about febrile seizures

  • Febrile seizures are a common childhood problem.
  • Seizures with a fever are more common in children between the ages of 6 months and 6 years.
  • They don't generally cause any lasting damage, even though they might look scary.
  • Stay calm and keep them safe.
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  • Febrile seizures are a common childhood problem.
  • They are triggered by a fever that is usually caused by a viral infection.
  • They can look scary, but they hardly ever cause long-term problems.
  • The most important thing is to try to keep calm, and keep your child safe – after the seizure, lie your child down on their side, in the recovery position.
  • Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if the seizure lasts more than 5 minutes, or if your child has trouble breathing, or you are worried.
  • When your child is having a seizure, don't put anything in their mouth and don't put them into a bath or shower to cool down.
  • Take your child to your family doctor afterwards to find out why they have a fever.

The word febrile means ‘with fever’. A febrile seizure is an epileptic seizure that happens when a child has a fever but febrile seizures are not the same as epilepsy. 
People have sometimes called febrile seizures fever fits, or febrile convulsions.

  • Febrile seizures are common 
  • Febrile seizures are common - about 1 in 20 children have them.
  • Febrile seizures usually happen between the ages of 6 months and 6 years.
  • There is a higher chance of your child having a febrile seizure if a close relative had febrile seizures as a child.
  • about 1 in 20 children have them.
  • Febrile seizures are common - about 1 in 20 children have them.
  • Febrile seizures usually happen between the ages of 6 months and 6 years.
  • There is a higher chance of your child having a febrile seizure if a close relative had febrile seizures as a child.
  • Febrile seizures usually happen between the ages of 6 months and 6 years.
  • There is a higher chance of your child having a febrile seizure if a close relative had febrile seizures as a child.

Many infections in children cause fevers. Some children are born with genes that make them more likely to have seizures when they have a fever. The fever does not cause the seizure but can trigger one in these children. Children with febrile seizures do not have a seizure with every fever. In fact, most children will only ever have 1 febrile seizure in their lifetime. For more information, see febrile seizures - more about the cause.(external link)

Usually, the fever is caused by a viral infection such as a cold. Sometimes, the fever is caused by a bacterial infection, such as pneumonia, a urine infection, an ear infection or occasionally, meningitis. Bacterial infections can be serious.

Take your child to your family doctor after the febrile seizure to find out why they have a fever. 

Most febrile seizures stop by themselves.

When your child has the seizure they will become unresponsive. They may become stiff or their arms and legs may start to twitch or jerk. Their eyes may roll back. Often they are floppy afterwards.

The seizure can seem to go on for a long time but they usually only last a minute or two and will stop by themselves.

After the jerking or stiffness stops, your child will usually sleep for a while (up to an hour). Some children appear to be very upset and then become sleepy.

Watching your child have a febrile seizure can be very frightening, especially if it is the first time. Many parents think their child is dying during the seizure. Children don't die during febrile seizures.

Most febrile seizures stop by themselves.

How do I keep my child safe?

The most important thing to do is to keep your child safe while they are having a seizure.

  • Lie your child down on their side.
  • Don't put anything in their mouth (they will not swallow their tongue).
  • Don't put your child in the bath or shower to cool them down.
  • Loosen their clothes around their face and neck.
  • Wait a few minutes for the seizure to stop – check the time if you can to see how long the seizure lasts.

When should I see a doctor?

You should take your child to see a doctor after the seizure finishes. The doctor will check to see what is causing the fever.

When should I see a doctor urgently?

Most children are sleepy after a seizure, but if they are hard to rouse, or if you are worried about them for other reasons, see a doctor urgently.

When should I dial 111?

Dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help if:

  • the seizure lasts longer than 5 minutes
  • your child is having trouble breathing
  • your child looks very unwell
  • your child is not waking up and responding after the seizure.

A febrile seizure in a healthy child very rarely causes long-term harm. Febrile seizures lasting less than an hour do not cause brain damage or death.

Will they have another one?

Between 10 and 15 in 100 children (10–15%) have more than 1 seizure in the same illness. Once the seizure has finished, take your child to a doctor again.

If your child starts a second seizure before waking from the first one you should dial 111 within New Zealand (use the appropriate emergency number in other countries) for urgent medical help.

About 1 in 3 children who have had 1 febrile seizure will have another 1 with another fever. This is more likely to happen if there are other people in your family who have had febrile seizures. The risk decreases as your child gets older.

By the age of 6 years, children have usually grown out of febrile seizures.

Febrile seizures are not a form of epilepsy and do not cause epilepsy. The risk of any child developing epilepsy is 1 in 200. The risk is slightly higher (1 in 100) for children who have had a febrile seizure. This is because they have genes which make epilepsy more likely. The chance of a child developing epilepsy is higher again (less than 15 in 100) if:

  • a child has developmental delay
  • the febrile seizure lasted longer than 15 minutes, involved one side of the body or there was more than one seizure in the first illness
  • there are other people in the family who have epilepsy.

Most febrile seizures stop by themselves in 1 or 2 minutes. They do not need any treatment. 

If the seizure lasts longer than 5 minutes, dial 111 within New Zealand (use the appropriate emergency number in other countries) and ask for urgent medical help.

If your child had a febrile seizure that lasted more than 5 minutes, your doctor may give you some medication to use in case a future seizure lasts longer than 5 minutes

If your child recovers completely from the febrile seizure, and they do not have a serious infection, they do not need to stay in hospital.

There is no way to prevent febrile seizures.

Keeping your child cool when they have a fever will make them feel more comfortable but will not prevent a febrile seizure. The best ways to bring your child's temperature down are by:

  • undressing your child so that they are just wearing a single layer (for example, a singlet and pants)
  • making sure the room is not too hot or too cold.

If your child is miserable because of the fever, you can give them paracetamol to make them more comfortable. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose. You can also use this paracetamol dose calculator to work out how much to give your child depending on how much they weigh. 

Giving regular paracetamol or ibuprofen will not prevent a febrile seizure.

Management of febrile seizure in children

A child with a fever and an epileptic seizure has one of the following:

  1. An acute symptomatic epileptic seizure (e.g. in a child with meningitis or encephalitis).
  2. A febrile seizure.
  3. Epilepsy ( e.g. in an individual who has, or will, develop epileptic seizures without fever but at this time the epileptic seizure has been triggered by a fever or illness).

Febrile seizure (previously febrile convulsions) is a diagnosis given to children who have epileptic seizures, only with fever, between the age of 6 months and 6 years.

A child with a febrile seizure has the same risk for serious sepsis as another child of the same age presenting with fever alone and should be investigated and managed according to the same criteria used for other children presenting with a febrile illness.

Children with febrile seizures with a feature of concern should be referred to a paediatrician. Features of concern include any of the following:

  • more than 3 febrile seizures in 24 hours
  • child is under 6 months or over 6 years of age
  • seizures are longer than 30 minutes
  • seizures have focal signs
  • seizures are not tonic-clonic.

Consultation

  • Check airway, breathing, circulation and blood glucose. If blood sugar level <3 mmol/L: arrange immediate transport by ambulance for acute paediatric assessment and treat immediately with 15 g fast-acting carbohydrate.
  • For simple febrile convulsions (a single generalized seizure in 24 hrs with no focal feature lasting less than 15 min) determine the cause of the fever after the seizure has stopped (the most common are viral respiratory infections).
  • Review medical history of seizures.
  • Consider meningitis in any unwell child, especially younger children. Children with a seizure with a fever under 6 months of age should have a lumbar puncture unless contraindicated.
  • Investigations, including an EEG, are not indicated in febrile seizures.

Guidelines

Clinical guidelines for seizures – febrile(external link) Starship, NZ, 2022
Identifying the risk of serious illness in children with fever(external link) BPAC, NZ
Epilepsy guidelines and pathways for children and young adults(external link) Starship, NZ, 2022

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Credits: Content shared between HealthInfo Canterbury, KidsHealth and Health Navigator NZ as part of a National Health Content Hub Collaborative.

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