Febrile Seizures

Young children are prone to frequent viral illnesses and ear infections that are often associated with fever. When a young child has a fever he or she is at risk for having a febrile seizure. We consider a child to have had a febrile seizure of they have a seizure between age 6 months and 5 years that is associated with fever but not accompanied by any evidence of a central nervous system infection such as meningitis or encephalitis. About 5% of all children will have a febrile seizure. Most of these seizures are brief and last less than 1-2 minutes but can last up to 15 minutes and consist of sudden stiffening with some twitching of the extremities. This is called a generalized seizure. Rarely focal components may be present with one part of the body showing more involvement then another. Your child’s eyes may deviate upward and skin color may become pale but usually not blue. Your child will not respond to voice or touch and when the episode stops your child usually will go to sleep.

If your child has a seizure the most important response is to maintain your child’s airway and seek help. Turn your child on his side in a recovery position and maintain head and neck control so the upper windpipe does not close off. This also prevents your child from aspirating stomach contents if vomiting occurs. Vomiting is uncommon with febrile seizures. Call 911 or contact your doctor directly if the seizure has stopped and your child is resting comfortably. Your child will require a medical evaluation unless you are experienced with febrile seizures and your child has a history of similar febrile seizures in the past that you are comfortable handling. In most situations for the first febrile seizure and for all seizures in children under preschool years a medical evaluation and examination are needed.

If your child is under age 1 year and has not been immunized fully with HIB or Prevnar vaccines or has been receiving antibiotic that could be masking symptoms then a spinal tap may be needed. If your child shows any signs of a central nervous system infection then a spinal tap will be needed.

An EEG is not needed if a neurologically healthy child has a febrile seizure unless that seizure is complex. Laboratory testing is also rarely needed and should only be done if an evaluation of the cause of the fever is required. There is no need to pursue neuroimaging (CT or MR scans) are also not needed.

If your child has a febrile seizure there is a 30% risk of another febrile seizure before age 6 years. If a second seizure then there is a 50% risk. Seizure medications are not prescribed for the chronic management of children with febrile seizures. On rare occasions the use of a prophylactic benzodiazepine medication is considered for recurrent febrile seizures.