What Parents Need To Know About Febrile Seizures

Seizures are very scary for parents, especially when a baby or young child is seizing. While seizures can be serious, not all seizures carry the same risks or complications. The febrile seizure is an important example. Most febrile seizures end without treatment and do not require seizure medication for prevention.

What Is A Febrile Seizure?

Febrile means having or showing the symptoms of a fever. Febrile seizures are short seizures that are triggered by a fever. To be considered a febrile seizure, a child must have a fever of 100.4F or 38C or higher within 24 hours either BEFORE OR AFTER the seizure (a fact many parents don’t know!).

Febrile seizures can occur in children between the ages of 3 months and 6 years. First time febrile seizures are most common between the ages of 12 to 18 months.

It’s important to remember that not all fevers cause seizures. In fact, most fevers do not cause seizures, and while all children will experience a fever at least once, most children will never experience a febrile seizure. These seizures are generally rare and only affect approximately 2-5% of children.

Febrile seizures are something a lot of parents worry about, so today I am going to answer some common questions about febrile seizures and give you tips for handling a febrile seizure in case your child is one of the small percentage of kids who experience one.

What’s the difference between simple and complex febrile seizures?

There are two types of febrile seizures – simple febrile seizures and complex febrile seizures.

Simple febrile seizures last from a few minutes up to 15 minutes and occur one time in a 24 hour time period. Simple febrile seizures are what medical professionals call “generalized whole body seizures,” this means the seizure affects their body on both sides.

Symptoms of a generalized seizure may include:

• Whole body shaking, twitching, or jerking
• Open eyes and rolled back eyes
• Unconsciousness
• Vomit
• Loss of bladder or bowel control

Complex febrile seizures last longer than 15 minutes and occur more than one time in a 24 hour time period. They can be generalized seizures, affecting the whole body, or they can be confined to just one side or even one area of the body.

What Causes Febrile Seizures?

Febrile seizures are caused by the spike in temperature your child’s body is experiencing. They usually happen when a child has a viral infection (influenza, adenovirus, and parainfluenza are all notably associated with febrile seizures), but they can also happen with bacterial infections.

Family history is another thing to look for as a possible risk factor for febrile seizures; they are more common when someone else within the family experienced febrile seizures as a young child. It’s also important to be aware that a child who has had one febrile seizure will have an increased chance of having a second febrile seizure, especially if that first seizure happened before the child was 15 months old.

Do febrile seizures cause brain damage?

Short seizures do not cause damage to the brain. While a child may turn blue during a seizure, they are still getting oxygen to their brain during the seizure if it lasts less than five minutes. With most febrile seizures usually lasting less than three minutes, there is no risk of brain damage.

Are febrile seizures epilepsy?

Epilepsy, by definition, is two or more unprovoked seizures that are 24 hours apart. (When someone has two seizures within 24 hours, they are considered to be one event.) Febrile seizures are not epilepsy, and having one febrile seizure does not mean your child is destined to develop epilepsy later in life.

The risk rate of epilepsy in the general public is 1%. This risk rate rises to 2% in people who have a history of complex febrile seizures.

If your child is over the age of six and experiences a seizure with fever, it is not considered a febrile seizure. In addition to making an appointment with your pediatric care provider, you will want to consult a pediatric neurologist to check for epilepsy or other causes for the seizure. 

Is a quickly rising fever or higher temperature fever more likely to cause a febrile seizure?

There are mixed reviews in the research that has been done on febrile seizures, but a lot of literature points to how fast the rise in temperature takes place. This is consistent with the fact that the actual temperature of the fever is often less important than the overall picture of how your child looks (Is your child acting differently? Having trouble breathing? Dehydrated?). The number on the thermometer does not necessarily tell you how sick your child is or indicate a higher risk for a febrile seizure.

When it comes to diagnosing febrile seizures, it is less about the rapid timing or height of the fever – your medical provider is looking to see if there was a fever of at least 100.4F within 24 hours before or after a seizure.

Should I give my child Tylenol or Ibuprofen to try to prevent febrile seizures?

Because most children will not experience a febrile seizure, you should follow your pediatric provider’s normal care instructions when your child has a fever. Most fevers do not need to be treated with fever reducers. If your child has experienced a febrile seizure in the past or there is a family history of febrile seizures, you should discuss specific fever treatment plans for your child with your pediatric care provider.

What should I do if my child is having a febrile seizure?

It is never wrong to call 911 during a seizure or if you do not feel comfortable as a parent.

If your child has a febrile seizure:

• Stay as calm as possible.
• Time the seizure, your pediatric care provider will need to know how long it lasted.
• Make sure your child is on a safe surface, such as the floor, and cannot fall down or hit something hard.
• Lay your child on his or her side to prevent choking. This is especially important if your child has a lot of saliva coming out of his mouth.
• Watch for breathing problems, including any change of color in your child’s face.
• If the seizure lasts more than 3 minutes, or your child turns blue, call 911 right away.
• If your child has a history of febrile seizures, and was prescribed a rescue medication, give the rescue medication at 3 minutes and call 911.

It’s equally important to know what you should NOT do DURING a febrile seizure:

• Do not try to hold or restrain your child.
• Do not put anything in your child’s mouth.
• Do not try to give your child fever-reducing medicine.
• Do not try to put your child into cool or lukewarm water to cool off.

Take your child to the emergency room or call 911 immediately if:

• The seizure lasts more than 3 minutes.
• The seizure involved only certain parts of the body instead of the whole body.
• Your child is having trouble breathing or is changing color.
• Your child looks sluggish and is not responding normally.
• Your child doesn’t go back to normal behavior for an hour or more after the seizure.
• Your child looks dehydrated.
• Another seizure happens within 24 hours. 

How can I prevent febrile seizures?

Unfortunately, sometimes the first sign of a febrile illness in children with febrile seizures is the actual seizure, because a febrile seizure can happen when a child has a fever within 24 hours before or after the seizure. If your child has already had one febrile seizure, the following tips may help to prevent future febrile seizures:

• On-time and up-to-date vaccinations (including the annual influenza vaccine!) It is still possible to have febrile seizures in a fully vaccinated child, because immunizations do not prevent ear infections or all upper respiratory illnesses with fever symptoms. However, vaccines are one of the best ways to prevent febrile seizures as they greatly reduce the risk of meningitis-related febrile seizures. Meningitis symptoms include a stiff neck, a lot of vomiting, a bulging soft spot or fontanelle, excessive crying, or lethargy. If you see these symptoms, seek immediate medical attention.

• Handwashing
• Identifying the source of the fever and treating the illness that is causing it.
  • If your child has a bacterial infection, your pediatric healthcare provider may prescribe antibiotics. The full course of antibiotic should be taken, even if your child begins feeling better before the prescription is finished.
  • For viral infections, you will offer supportive care. Hydration is key to supportive care, and you can help your child stay hydrated with water and Pedialyte. If your child is a baby, they should have at least 6-8 wet diapers daily. Your pediatric healthcare provider may also have you treat your child with fever reducers. You can give Tylenol (Acetaminophen) every 4-6 hours or Advil (Ibuprofen) every 6-8 hours, as needed, if the fever persists. Do not alternate these medications in an effort to give doses more frequently or give more doses than allowed in 24 hours.

To learn more about treating fevers in children, check out this post with five important fever facts. If your child does not have a history of febrile seizures, a fever on its own is usually not a bad thing. It is the body trying to rid itself of an infection or illness and can be part of the healing process.

Author: Dr. Melissa Rumple DNP CPNP-PC APN-Genetics
Dr. Melissa Rumple is a Pediatric Nurse Practitioner and Advanced Practice Nurse in Genetics at Banner Child Neurology. Prior to subspecializing, she opened and practiced in a primary care clinic as a Pediatric Nurse Practitioner. Dr. Rumple works with a Pediatric Neurologist and Pediatric Nurse Practitioner, and their team is consulted on pediatric neurology inpatients at Banner Children’s at the Banner Thunderbird Medical Center in Glendale, AZ. At her current practice, she sees outpatient pediatric neurology patients with developmental delays, epilepsy, and headaches, but she subspecializes in neurodevelopmental genetic diseases within the Child Neurology Clinic. Her special interest within child neurology and genetics is diagnostic odyssey patients. She has been published in Molecular Cytogenetics for new genetic cases and presented rare genetic cases at the American Academy of Neurology (AAN) and National Association of Nurse Practitioners (NAPNAP).