Febrile Seizure

General Overview

  • Convulsion in 6mo-5yo associated with fever (T>38°C)
    • Absence of CNS infection/inflammation, metabolic abnormality
    • No history of previous afebrile seizures
    • Other typical
      • Usually first day of illness
      • Can have postictal drowsiness 5-10 mins
  • Simple
    • <15 mins
    • No focal features (generalized tonic-clonic or atonic/tonic)
    • Once in 24h
  • Complex
    • >15 mins
    • Focal features or postictal paresis
    • >1 in 24h
  • DDx
    • Shaking chills (usually fine oscillatory movements around a joint, rarely involve face/respiratory muscles)
    • CNS infections (meningitis, encephalitis)
      • Altered consciousness, petechial rash
      • Unvaccinated to Strep pneumo and H influenzae type B
    • Genetic epilepsy (rare)


  • Seizure characteristics
    • Duration (reliability)
    • Focal features (limited to one limb, or one side of body)
    • Postictal drowsiness (>10mins)

Physical Examination

  • ABC, Vitals
  • LOC
  • Seizure ended (closed eyes, deep breath)
    • If persistent open and deviated eyes, they may still be seizing even if motor activity stopped
  • Meningeal signs
    • Stiff neck
    • Bulging fontanelle
    • Skin Rash
  • Neuro
    • Focal differences in muscle tone, strength, movements


  • Lumbar puncture if
    • Meningeal signs or symptoms
    • 6-12 months of age if unvaccinated (or undetermined) Haemophilus influenzae type b or Streptococcus pneumoniae
      • <6 months as not considered a febrile seizure
    • Treated with antibiotics prior (as can mask signs/symptoms of meningitis)
    • Febrile status epilepticus (>30 mins)
    • Seizures after second day of febrile illness
  • Consult pediatric neurology for complex seizure
    • Consider imaging (CT C+ or MRI) if abnormally large head, persistent abnormal neurological exam, focal features, or sign of increased ICP
    • Consider EEG if prolonged seizure or focal for prognosis


  • 1 in 25 children will have a febrile seizure
    • 1 in 3 will have another one
    • The older they are, the less likely they will have another
    • Tylenol (Acetaminophen) and Advil (Ibuprofen) for symptoms, but will not prevent seizures
  • If your child has another febrile seizure
    • Stay calm
    • Place child on their side on a flat surface in a safe environment
    • Do not restrain them
    • Do not put anything in their mouth (you can wipe away vomit or saliva outside the mouth)
    • Call 9-1-1 if the seizure lasts longer than 5 minutes

Status Epilepticus Management