Febrile Seizures (Seizures With Fever)

Although febrile seizures are not technically epilepsy, they deserve a chapter of their own in this book because they are the type of seizure families encounter most often and fear the most. The good news: febrile seizures are extremely common, and in the vast majority of cases completely harmless.

What Is a Febrile Seizure?

A febrile seizure is a seizure that occurs together with a fever in children between 6 months and 5 years of age, without an infection that directly affects the brain (such as meningitis). It is the most common type of seizure in childhood; it happens at least once in about 2 to 5 percent of children. It usually occurs in the first hours, as the fever rises quickly.

Simple Versus Complex Febrile Seizures

Febrile seizures fall into two groups, and this distinction matters in figuring out how a child is likely to do:

• Feature
• Simple Febrile Seizure
• Complex Febrile Seizure
• Duration
• Less than 15 minutes
• Longer than 15 minutes
• Type
• Involves the whole body (generalized)
• May involve just one side of the body (focal)
• Recurrence within 24 hours
• Does not recur
• May recur during the same illness
• Frequency
• More common (the majority)
• Less common

Simple febrile seizures make up the vast majority of febrile seizures and are the ones with the best outlook. Complex febrile seizures, on the other hand, call for closer evaluation.

• The Two Most Common Questions
• “Will my child develop epilepsy?”

This is families' biggest fear. The reality is that the vast majority of children who have a febrile seizure do not go on to develop epilepsy. A child who has a simple febrile seizure has only a very slightly higher risk of developing epilepsy later than a child who has never had one — a level quite close to the risk in the general population. In complex febrile seizures, the risk rises somewhat when there is a family history of epilepsy or a pre-existing neurological problem.

“Will it happen again?”

There is a chance of recurrence; it is more likely in children who have their first seizure at a young age, who have a family history of febrile seizures, or who have a seizure with a relatively low fever. But even if it does recur, in most cases it does not change the child's long-term outlook.

Treatment Approach

In simple febrile seizures, taking a daily epilepsy medication on an ongoing basis is not recommended, because the possible side effects of the medications outweigh the benefit they provide. For seizures that recur often or last a long time, your doctor may prescribe an intermittent treatment to be used during feverish periods, or a rescue medication to stop a seizure at home. Fever reducers make the child more comfortable, but on their own they are not enough to prevent a seizure.

Stay Calm During a Febrile Seizure

Lay your child on their side on a safe, soft surface. Do not put anything in their mouth.

Time how long the seizure lasts by looking at a clock.

Call emergency services if the seizure lasts longer than 5 minutes, if the child turns blue, if they do not come around afterward, or if it is happening for the first time.

Even after the seizure has passed, see a doctor to find the cause of the fever; meningitis should be ruled out, especially in babies under 12 months.