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Febrile seizures
A febrile seizure is a seizure in a child aged 6 to 60 months with fever and without a central nervous system infection; a simple febrile seizure needs no neurological work-up, and the main task is to find the source of the fever and reassure the parents.
Why it matters in the exam
The exam describes an 18-month-old who had a seizure at home during a fever and is now awake and playing. The question asks what must be done, and the correct answer is usually "nothing beyond finding the source of the fever": no EEG, no imaging, no routine blood tests and no preventive treatment. The difference between a simple and a complex seizure is tested too, as is the question of when to do a lumbar puncture.
Other questions deal with prognosis: about a third of children will have another seizure, and the risk is higher when the first seizure occurred before 18 months, at a relatively low temperature, after a short period of fever or with a family history. The risk of epilepsy after a simple febrile seizure is only slightly higher than in the general population. Antipyretics do not prevent recurrence.
Advising the parents is part of the right answer: lay the child on the side, put nothing in the mouth, time the seizure and call for help if it lasts more than a few minutes. Children with prolonged or recurrent seizures can be given a benzodiazepine for home use. It is also worth explaining that the seizure, frightening as it is, does not harm development or intelligence.
Key points
- Age 6–60 months, fever, no brain infection.
- Simple: generalised, less than 15 minutes, once in 24 hours.
- In a simple seizure: only look for the source of fever; no EEG, no imaging.
- About a third will have another seizure, especially if the first was before 18 months.
- In a seizure lasting more than 5 minutes: a benzodiazepine.
Summary table
| Type | Definition | Work-up | Note |
|---|---|---|---|
| Simple febrile seizure | Generalised, less than 15 minutes, once in 24 hours | Source of fever only; no EEG, no imaging | The common type |
| Complex febrile seizure | Focal, or 15 minutes or longer, or recurs within 24 hours | Work-up by the picture; consider EEG and imaging | Slightly raised risk of epilepsy |
| Febrile status epilepticus | 30 minutes or longer, or a series without regaining consciousness | Emergency treatment; neurological work-up | Benzodiazepine after 5 minutes |
| Suspected brain infection | Meningeal signs, prolonged drowsiness, bulging fontanelle | Lumbar puncture | Consider an LP also at 6–12 months if unvaccinated or after antibiotics |
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Sources
- AAP Clinical Practice Guideline: Febrile Seizures — Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure, 2011 — Lumbar puncture, EEG, laboratory and imaging
- AAP Clinical Practice Guideline: Febrile Seizures — Long-term Management of the Child With Simple Febrile Seizures, 2008 — Antipyretic and anticonvulsant therapy
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Febrile Seizures
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.