What is a febrile seizure?
A febrile seizure (febrile fit) is a convulsion triggered by fever in children aged 6 months to 5 years, most often between 12 and 18 months. It happens when the body temperature goes above 100.4°F (38°C), usually within 24 hours of the fever starting.
- It is the most common type of seizure in children.
- There are two types: simple febrile seizures and complex febrile seizures.
- It is not epilepsy, and it usually does not affect the child's brain development or intelligence.
- Most children stop having febrile fits by 6 years of age.
The fever is usually from common infections such as a cold, flu-like illness, ear infection or urinary infection. Some children have a family member who had febrile fits or epilepsy.
What to do when your child has fever next time
- Check the temperature with a thermometer and note it down.
- Do not overdress your child.
- Sponge the whole body, including the head, with tap water.
- Give fever medicine at the start of fever, in the dose advised by your pediatric neurologist or pediatrician.
- Give plenty of fluids to prevent dehydration.
- Get the cause of the fever checked and treated.
In some children the doctor may prescribe a short course of a preventive medicine during fever. Only use this if it has been advised for your child.
A simple febrile seizure usually does not need an MRI or EEG. These tests may be needed for complex febrile seizures.
Will it happen again?
About 40 percent of children who have a febrile fit will have another one. The chance is higher if the first fit happened before 18 months, if the child's development is delayed, if the fever was present for less than an hour before the fit, if the fit happened at a temperature below 100.4°F, or if there is a family history of febrile seizures or epilepsy.
The risk of epilepsy after simple febrile seizures is about 1 percent, similar to any other child. The risk is higher after complex febrile seizures, very long febrile fits, a family history of epilepsy or developmental delay.
What is epilepsy?
Epilepsy is a neurological condition that causes repeated fits. Normal brain activity is disturbed, leading to bursts of excess electrical activity in the brain. When a child has two or more fits at least 24 hours apart, it is called epilepsy.
Common triggers to avoid
- Fever
- Lack of sleep
- Flashing light patterns
- Fasting or missing meals
- Stress
- Excessive screen time
Tests and treatment
Always consult a pediatric neurologist if epilepsy is suspected. During an active fit, take the child to the nearest emergency.
Before diagnosing epilepsy, the pediatric neurologist takes a detailed history and examines the child, then may advise:
- Blood tests
- EEG (electroencephalogram), sometimes video EEG to record the fits
- MRI or CT scan of the brain
- Genetic, metabolic or autoimmune tests in some cases
The first line of treatment is anti-seizure medicines. Some children need just one medicine, while others need more than one. Most children become seizure free with the right medicines.
- Give the medicines in the correct dose, regularly, exactly as advised.
- Missing doses increases the chance of fits.
- Keep a diary of how often fits happen and what they look like.
- Come for follow up regularly.
What to do during a fit
- Stay calm. Note the time the fit starts and ends.
- Do not move the child unless they are in danger. Clear away furniture and hard objects.
- Do not hold the child down. Turn them on their side to keep the airway clear and stop them swallowing vomit.
- Loosen tight clothing around the neck.
- Put nothing in the mouth and do not make them smell anything.
- Give nothing by mouth until fully recovered.
- If you can, take a video of the fit for the doctor.
- If a rescue medicine such as nasal midazolam has been prescribed, give it as instructed if the fit lasts more than 2 minutes.
Get medical help straight away if
- The fit continues even after the rescue medicine
- One fit follows another
- Your child is injured or you are worried about their breathing
- You are frightened or feel your child needs medical attention
Daily life, school and sports
A child with epilepsy should be treated as a normal child as far as possible. Avoid overprotection. If fits are not well controlled, activities like cooking, swimming and cycling should be supervised.
Your child should go to a regular school. Tell the teacher about the condition and the medicines. A laminated card in the pocket with the doctor's name and number and the current medicines is very useful. Teachers can be trained to recognize a fit, position the child safely and give the rescue spray if the fit lasts more than 2 minutes.
Sports like cycling, gymnastics, skating and swimming carry moderate to high risk. Always use a helmet and make sure an adult is watching.
Sleep tips
- Keep the bedroom quiet and dark.
- Go to bed at least half an hour before trying to sleep.
- No television in bed.
- No tea, coffee or fizzy drinks for 6 hours before bedtime.
- Exercise daily, but not in the few hours before bed.
Questions parents often ask
Is a febrile seizure the same as epilepsy?
No. A febrile seizure is a fit triggered by fever in young children and it is not epilepsy. The risk of developing epilepsy after a simple febrile seizure is about 1 percent.
Can a child with epilepsy go to a normal school?
Yes. Most children with epilepsy attend regular school. Inform the teacher, share the medicine details and a rescue plan, and supervise risky activities.
How long will my child need epilepsy medicine?
It depends on the type of epilepsy. Many children who stay seizure free for around two years can slowly come off medicines under the guidance of their pediatric neurologist. Never stop medicines on your own.
When should I call an ambulance during a fit?
Seek emergency help if the fit continues after the rescue medicine, lasts more than 5 minutes, repeats without recovery in between, causes injury or affects breathing.