Utah Medical Home Portal - Febrile Seizures

Guidance for primary care clinicians diagnosing and managing children with febrile seizure

According to the American Academy of Pediatrics, a febrile seizure is a seizure accompanied by fever (temperature ≥ 100.4°F or 38°C2 by any method), without central nervous system infection, that occurs in infants and children 6 through 60 months of age. [Subcommittee: 2011] Typical children have a 2-5% risk of febrile seizures. [Baumann: 2000]

Other Names

Febrile convulsions

Key Points

Characteristics of a simple febrile seizure [Subcommittee: 2011]

The seizure occurs in a normally developing child without underlying neurologic problems, evidence of meningitis or encephalitis, or metabolic disturbances.
The child is 6 months to 5 years of age.
The fever is present before or with the seizure.
The seizure is generalized, involving arms and legs.
There is only 1 seizure in 24 hours.
The seizure lasts less than 15 minutes.

Complex febrile seizures
Children with complex febrile seizures have a different prognosis and treatment than those with simple febrile seizures. If the seizure has any of the following features, it is a complex febrile seizure:

Focal features
Prolonged (greater than 15 minutes)
Recurs within 24 hours of a first febrile seizure

Practice Guidelines

Subcommittee on febrile seizures.
Neurodiagnostic evaluation of the child with a simple febrile seizure.
Pediatrics. 2011;127(2):389-94. PubMed abstract

Diagnosis

In the clinical setting of a simple febrile seizure (i.e., a child with the appropriate history and normal exam), brain imaging, blood studies (CBC, electrolytes, calcium, phosphorus, magnesium, glucose), and EEG are not thought to be necessary for children over a year of age.

The American Academy of Pediatrics (AAP) recommends that a lumbar puncture be strongly considered in children:

<12 months old
With any sign of intracranial infection, such as neck stiffness or Kernig and Brudzinski signs
That might have been pre-treated with antibiotics

The AAP also recommends that a lumbar puncture be considered in children from 12 to 18 months, as meningeal signs might be difficult to appreciate in this age group. [Subcommittee: 2011] The risk for meningitis in a child with a simple febrile seizure is low. [Guedj: 2015]

Prevalence

There is a 2-5% risk of febrile seizures in typical children. [Baumann: 2000]

Prognosis

The recurrence risk for future febrile seizures is 50% for children under 1 year, 30% for children over 1 year, and 50% for children who have experienced 2 febrile seizures (not given by age range).

Simple febrile seizures are generally benign and have a good prognosis; the child is unlikely to have developmental problems or future epilepsy. Treatment does not appear to improve long-term outcomes, and good outcomes are expected.

In more detail, the risk of epilepsy for all children with febrile seizures is 2-5%; this increases to about 10% when the child has 2-3 risk factors. Risk factors include age less than 12 months, multiple febrile seizures, a family history of epilepsy, a prior neurologic insult, or an abnormal baseline neurologic exam. [Mewasingh: 2020] [Lee: 2016]

Treatment

Treatment of the fever by acetaminophen or ibuprofen does not prevent the reoccurrence of febrile seizures. [Pavlidou: 2006] Although a continuous course of antiepileptic medications might be effective in decreasing febrile seizure recurrence, febrile seizures do not warrant the potential toxicities of these medications. Treatment does not appear to improve long-term outcome in febrile seizures, and outcome is good without medical intervention. Although evidence is lacking, a prescription for rectal diazepam or nasal midazolam is sometimes given for home use in children with prolonged, frequent febrile seizures. [Kimia: 2015] See [Subcommittee: 2011] and [Kimia: 2015].

ICD-10 Coding

R56.00, Simple febrile convulsions

Resources

Information & Support

Related Portal Content
Assessment and management information for the primary care clinician caring for the child with different kinds of seizures:

For Parents and Patients

Febrile Seizures in Children (Bright Futures)
Causes, treatment, and safety during a febrile seizure.

Helpful Articles

PubMed search for articles on Febrile Seizures in children for the last 3 years.

Smith DK, Sadler KP, Benedum M.
Febrile Seizures: Risks, Evaluation, and Prognosis.
Am Fam Physician. 2019;99(7):445-450. PubMed abstract

Authors & Reviewers

Initial publication: April 2013; last update/revision: December 2022

Current Authors and Reviewers:

Author:	Lynne M. Kerr, MD, PhD
Reviewer:	Cristina Corina Trandafir, MD, PhD

Authoring history

2019: update: Lynne M. Kerr, MD, PhD^A

2013: first version: Lynne M. Kerr, MD, PhD^A

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer

Page Bibliography

Baumann RJ, Duffner PK.
Treatment of children with simple febrile seizures: the AAP practice parameter. American Academy of Pediatrics.
Pediatr Neurol. 2000;23(1):11-7. PubMed abstract

Guedj R, Chappuy H, Titomanlio L, Trieu TV, Biscardi S, Nissack-Obiketeki G, Pellegrino B, Charara O, Angoulvant F, Villemeur TB, Levy C, Cohen R, Armengaud JB, Carbajal R.
Risk of Bacterial Meningitis in Children 6 to 11 Months of Age With a First Simple Febrile Seizure: A Retrospective, Cross-sectional, Observational Study.
Acad Emerg Med. 2015;22(11):1290-7. PubMed abstract

Kimia AA, Bachur RG, Torres A, Harper MB.
Febrile seizures: emergency medicine perspective.
Curr Opin Pediatr. 2015;27(3):292-7. PubMed abstract

Lee SH, Byeon JH, Kim GH, Eun BL, Eun SH.
Epilepsy in children with a history of febrile seizures.
Korean J Pediatr. 2016;59(2):74-9. PubMed abstract / Full Text

Mewasingh LD, Chin RFM, Scott RC.
Current understanding of febrile seizures and their long-term outcomes.
Dev Med Child Neurol. 2020;62(11):1245-1249. PubMed abstract

Pavlidou E, Tzitiridou M, Panteliadis C.
Effectiveness of intermittent diazepam prophylaxis in febrile seizures: long-term prospective controlled study.
J Child Neurol. 2006;21(12):1036-40. PubMed abstract

Subcommittee on febrile seizures.
Neurodiagnostic evaluation of the child with a simple febrile seizure.
Pediatrics. 2011;127(2):389-94. PubMed abstract