What to Do if Your Baby Has a Febrile Seizure: Tips for Parents

What Are Febrile Seizures?

Febrile seizures are seizures (convulsions) that occur in young children who have a fever. Most febrile seizures are short-lived and relatively harmless. Children who experience a febrile seizure (fever convulsion) usually recover quickly without any long-term health complications. In other words, febrile seizures are not a serious illness and do not cause brain damage. They commonly occur in 2-5% of healthy children. 

But you should seek emergency medical care if your child’s high temperature causes a febrile seizure for the first time or if your child has another seizure within 24 hours. 

Note: A history of febrile seizures may be associated with a slightly raised risk of developing epilepsy later in life. 

Who Gets Febrile Seizures?

Young children between the ages of 6 months and 5 years can get febrile seizures. Febrile convulsions are most common at a young age in children between 12 and 18 months of age. 

Types of Febrile Seizures

Simple Febrile Seizures

Simple febrile seizures are:

• A generalized tonic-clonic seizure (full body febrile convulsion that affects both sides of the child’s body).

• Last no more than 15 minutes.

• Do not occur more than once in 24 hours.

Complex Febrile Seizures

Complex febrile seizures are more likely to require medical treatment. A complex febrile seizure: 

• Affects one part of the body or one side of the body (these are called focal seizures or partial seizures). 

• Lasts more than 15 minutes. 

• The child does not recover fully within an hour. 

• More than one seizure occurs within 24 hours. 

Febrile Status Epilepticus

Febrile status epilepticus refers to prolonged febrile seizures lasting longer than 30 minutes. This is a rare condition but is associated with poorer outcomes compared to simple febrile seizures.

Why They Occur

Febrile seizures occur because of fever, typically when the child has a high fever with a body temperature at or above 100.4℉ or 38℃. Febrile seizures are most common when the child’s body temperature rises on the first day of an illness. However, some children can have a febrile seizure before they develop a fever. 

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Febrile Seizures vs Epilepsy

A febrile seizure is triggered by a fever or occurs a few hours before a fever develops. If a child has a febrile seizure, it does not mean they have a seizure disorder (epilepsy). Children with epilepsy have multiple seizures that are not triggered by fever.

Find out, “Seizure Disorder Vs. Epilepsy: What's The Difference?”

Causes of Febrile Seizures

Common Triggers

Viral infections that cause fever commonly trigger febrile seizures. The fever can be due to an ear infection, influenza, upper respiratory infections, Strep throat, tonsillitis, stomach flu (gastroenteritis), chickenpox, COVID-19, malaria, as well as more serious infections such as central nervous system infections (encephalitis, meningitis).

Some children experience febrile seizures after receiving routine childhood vaccinations. A febrile seizure that occurs after vaccination is because of the fever and not the vaccine. Prenatal exposure to nicotine has also been associated with febrile seizures.

Risk Factors

About 1 in 3 children who have one febrile seizure have another one at some point in the future. About 1 in 10 children who have one febrile seizure have three or more febrile seizures throughout childhood. The risk of recurrent febrile seizures is higher in:

• Children who have their first febrile seizure before 12 months of age.

• Children who have a febrile seizure associated with low-grade fever (most febrile seizures occur in association with high temperature). 

• Children in whom the febrile seizure is the first sign of illness. 

• Children who have an immediate family member with a history of febrile seizures.

Genetics

There may be a genetic component to febrile seizure risk. About 1 in 4 children who have febrile seizures have a family history of febrile seizures. 

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Common Signs and Symptoms of Most Febrile Seizures

Approximately 80% of febrile seizures are simple febrile seizures that typically occur on day one of a fever. During a febrile seizure, the child may have:

• Stiffening and tensing up of their muscles.

• Shaking involving both sides of the body.

• Loss of consciousness (passing out). 

• Eyes rolling back in the head.

• Drooling.

• Vomiting.

• Loss of bowel or bladder control (urinating (peeing) or defecating (pooping). 

Diagnosis of Febrile Seizures

Healthcare providers can diagnose febrile seizures based on your child’s symptoms and medical history. If your child has a febrile seizure, your child’s doctor will carefully review their medical history to identify the cause of the febrile seizure. They will also evaluate the child’s development to exclude risk factors for epilepsy. 

If your child has a simple febrile seizure and the cause of the fever is known (for example, a viral infection or bacterial infection), as long as your child is up-to-date on vaccinations and has normal development, no further testing is typically required. 

If your child is behind on the recommended vaccination schedule or has a weakened immune system, the healthcare provider may order blood tests, urine tests, and/or a spinal tap (lumbar puncture) to look for severe infections, such as brain and spinal cord infections.

If your child has complex febrile seizures or prolonged febrile seizures, the doctor may order an electroencephalogram or EEG test to measure electrical activity in the brain. They may also recommend imaging tests such as an MRI scan (magnetic resonance imaging), looking for things such as an unusually large head size, increased pressure in the skull, or abnormal neurological findings. 

First Aid and Treatment

Can You Treat a Febrile Seizure At Home? 

You should not treat a child’s first febrile seizure at home. Seek immediate medical care if you think your child has had a febrile seizure. 

Is A Febrile Seizure Harmless? 

Only a healthcare professional can decide that it was a relatively harmless febrile seizure and not some other type of seizure disorder. Your child’s doctor can also rule out severe, life-threatening infections like meningitis or encephalitis.

What To Do If My Baby Has A Febrile Seizure?

If your child has had febrile seizures before, the healthcare provider will guide you on how to treat any future febrile seizures at home. Follow these instructions carefully. The general recommendations are as follows:

• Remain calm. It can be frightening to see your child having a seizure but try to stay as calm as possible. 

• Time the seizure. Make a note of the time the seizure starts and stops. If the seizure lasts for 5 minutes or longer, call 911 for emergency medical assistance. 

• Gently place your child on the floor. Do not place them on a bed or table or hold them in your arms - this can increase the risk of injuries. 

• Lay your child in a rescue position, turned over to the left side with the arm stretched out to cushion their head. This position prevents choking on saliva or vomit. 

• Remove any sharp objects from the vicinity to keep your child safe.

• Loosen any tight clothing.

• Don't try to restrain the child's shaking movements.

• Don’t put anything in your child’s mouth.

When to Seek Emergency Care

Seek immediate medical care in an emergency room if:

• It is your child’s first febrile seizure.

• The seizure lasts more than 5 minutes.

• Your child has not recovered fully from the seizure after one hour.

• Your child has other signs and symptoms of serious infections, such as trouble breathing, a stiff neck, lethargy (inactivity or unresponsiveness), or repeated vomiting.

What Is The Basic Treatment For a Child’s First Febrile Seizure?

Simple febrile seizures don’t usually require any treatment. They are short-lived, and the child quickly makes a full recovery. You can give your child fever-reducing medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin), to keep them comfortable. However, these medications do not prevent febrile seizures. Giving the child a lukewarm bath or placing a cold cloth on their head or body also cannot prevent febrile seizures.

Children who have complex febrile seizures or prolonged febrile seizures may need to have the febrile seizures treated with a medication such as rectal diazepam (Diastat), diazepam nasally or orally, or midazolam liquid given nasally. 

Your child’s healthcare provider will tell you how to use these medications at home. Treatment with Diastat (rectal diazepam) is typically recommended for febrile seizures lasting more than 5 minutes or if the child has more than one seizure in 24 hours. This medication can cause side effects such as irritability, sleepiness, and poor coordination for several days afterward.

Read Next: “Seizure First Aid: A Step-By-Step Guide.”

Should I Let My Child Sleep After a Febrile Seizure?

Yes, you can let your child sleep after a febrile seizure. It's normal for a young child to be tired and want to sleep in the first few hours after a febrile seizure. The child can sleep in their own bed or crib. You can resume the child’s normal routine, including putting the child to bed at the regular time.

Treatment for Recurrent Febrile Seizures

In rare cases, some children with repeated seizures may need to take prescription antiseizure medications on a daily basis to treat seizures and prevent recurrent febrile seizures.

Medical Interventions and Follow-Up Care

Having simple febrile seizures does not cause any long-term harm and does not increase the risk of epilepsy. Children who experience complex febrile seizures are at a 2.5% to 5% higher risk of developing epilepsy later in life. However, they don’t typically have any health complications or require long-term medical care.

Prevention and Long-Term Management

Preventing and Reducing the Risk of Febrile Seizures

Febrile seizures are unpredictable, and you cannot take specific steps to prevent them. 

Prognosis

Most children who experience febrile seizures recover fully without any long-term health complications or neurological disorders. Having simple febrile seizures (the most common type of febrile seizures) is not linked to an increased risk of developing epilepsy (seizure disorders).

Reassurance for Parents and Caregivers

Watching your child have a febrile seizure or lose consciousness can be a frightening experience, especially if it is your child’s first seizure. Remember, most febrile seizures are short-lived and relatively harmless. Talk to your child’s pediatrician for guidance on how to manage future febrile seizures at home. Seek emergency medical care if your child has a febrile seizure for the first time, if the seizure lasts more than 5 minutes, or if your child has another seizure within 24 hours.