What Parents Should Know About Febrile Seizures in Kids

Trembling uncontrollably, my toddler’s tiny fingers locked into a claw while his beautiful blue eyes rolled toward the back of his head. I froze, absolutely terrified and totally unaware that my son was experiencing a febrile seizure.

Febrile seizures were simply not on my radar. Sure, I expected coughs, colds and the occasional fever, but an ambulance speeding around the neighborhood was an outcome I didn’t see coming. Feeling unprepared made the experience infinitely more alarming, but febrile seizures aren’t usually a major cause for concern.

What is a febrile seizure?

A febrile seizure—also known as a febrile convulsion—is a seizure triggered by fever. The term ‘febrile’ itself refers to the symptoms of a fever, so it makes sense that febrile seizures are often accompanied by a viral or bacterial infection that causes an increased body temperature, like a cold or flu or even meningitis. Most fevers linked to febrile seizure will exceed 100.4°F (38°C), however some will occur with a milder reading.

“A febrile seizure by definition is a seizure which occurs after a fever. If a seizure occurs in the absence of a fever, then it’s not a febrile seizure, it’s something else,” explains Ashlesha Kaushik, MD, FAAP, an American Academy of Pediatrics (AAP) national spokesperson, pediatric infectious disease specialist and clinical assistant professor of pediatrics at the University of Iowa.

“It’s the speed with which the fever rises that’s the key—not the height of fever, but the sudden rise of fever that can give them a [febrile] seizure,” Dr. Kaushik adds.

Febrile seizures mostly affect children between the ages of 6 months and 5 years, but despite the somewhat shocking presentation, they are generally harmless and usually require minimal management.

Symptoms of febrile seizures in children

Many families live with seizure disorders and are formidably prepared to treat an onset at all times. But for others an episode can feel frighteningly foreign, which is why it’s important to have a basic understanding of the symptoms of febrile seizures.

During a febrile seizure a child may:

Suddenly tighten their muscles which can make them appear rigid and stiff
Jerk their body rhythmically or shake uncontrollably
Lose consciousness in some cases, or their eyes may roll back
Some may also moan, vomit or urinate

Anything that exceeds 15 minutes is a complex febrile seizure. Anything below 15 minutes is considered a simple febrile seizure, which is usually associated with better outcomes.

According to the Centers for Disease Control and Prevention (CDC), most febrile seizures last for less than one or two minutes.

Sometimes a febrile seizure will be the first indication of an illness, and there won’t always be an obvious sign that an onset is imminent—including a high fever you might be expecting. In fact, the highest fever necessary to cause a febrile seizure is specific to the child—the individual convulsive temperature threshold varies. I found that fact hugely comforting after berating myself for seemingly ‘missing’ something in the lead up to my son’s episode.

How common are febrile seizures?

The National Institute of Neurological Disorders and Stroke (NINDS) reports that about 1 in every 25 children will experience at least one febrile seizure, with about 40% of those experiencing a recurrence.

Hamad Husainy, DO, FACEP, a practicing emergency physician in Alabama and a spokesperson for the American College of Emergency Physicians (ACEP), says he often sees children presenting with febrile seizures.

“In my community emergency department in a rural area, we see several every week,” Dr. Husainy says. “These patients rarely get admitted to the hospital and the overwhelming number of patients have stopped seizing on arrival to the emergency department.”

So it seems febrile seizures are relatively common, yet studies have shown that there’s little understanding among parents. For example, a 2021 study concluded that only one-third of parents understood that their child was having a febrile seizure while it was happening. Unsurprisingly, that same study also reported 89% felt high levels of anxiety.

Should I worry about febrile seizures?

Generally speaking, a simple febrile seizure is harmless. There’s no medical evidence that they will cause death, brain damage or learning difficulties, and most patients with febrile seizures do not require hospitalization or intensive medical interventions.

As for whether febrile seizures recur, one study found that age at the time of the first febrile seizure can be the most important factor for recurrence. Children who experienced their first episode younger than 1 year have a 50% chance of recurrence, while those older than 3 have a 20% possibility.

Parents may worry that a febrile seizure is indicative of other conditions like epilepsy, but that isn’t usually the case. Epilepsy, by comparison, is characterized by recurring seizures and not fever. But know that just 1% to 2% of children with simple febrile seizures will develop epilepsy, compared with about 0.5% of children without febrile seizures. The statistics are low. Children with complex febrile seizures are at a slightly higher risk at 6% to 8%. If epilepsy is diagnosed later, know that this is also a manageable condition with the right medical support.

Can you prevent febrile seizures?

Unfortunately, no. It’s important to note that using fever-reducing medications in your child won’t prevent febrile seizures, although they may improve your child’s comfort, states AAP.

Febrile seizures can be unpredictable and you can’t do anything to cause or prevent them besides comforting a child with a fever and educating yourself about the condition.

If a child has had a febrile seizure before, look out for similar symptoms and follow the advice given to you by your doctor who will likely have prepared you for the possibility of recurrence.

Routine childhood vaccinations against infections that typically lead to fevers can also be helpful in some cases, particularly if a child is exposed to viral and bacterial bugs regularly at places like daycare, says Dr. Kaushik.

What to do if your child experiences a febrile seizure

First and foremost, parents should remain calm (easier said than done). Due to the nature of the convulsive state, there is a small chance a child may be injured through a fall, or that they could choke on food or saliva in the mouth. Therefore, children should be positioned on their side on the floor to prevent injury. You should never restrain or hold a child during an episode, or place anything in their mouth including medicine.

It’s also beneficial to note the length of time of the seizure if possible. The NINDS suggest contacting an ambulance if the seizure lasts longer than 5 minutes or if the child doesn’t seem to be recovering quickly regardless of the duration. Immediate medical attention should be sought if this is the child’s first febrile seizure. If this has happened before, follow the advice given to you on presentation of the first seizure.

Your healthcare provider will ask you a series of questions about the seizure and the child’s medical and family history and run tests as appropriate. This will help them diagnose a simple or complex febrile seizure or a more severe illness presenting with a seizure like meningitis or encephalitis.

Once the initial infection has passed, most children will make a swift recovery (like mine did.)

A note on febrile seizures in kids

Following my son’s experience with a febrile seizure, I’ve become much more sensitive around illnesses that he picks up. A common cold, for example, is now something of a red flag. I’ve noticed I measure his temperature much more frequently and I’m administering medication at the earliest sign of discomfort. This may seem a bit over the top as the science doesn’t suggest this is necessarily more effective, but the ‘mama bear’ instinct is real.

Essentially, the best way we can provide for our children is to educate ourselves about febrile seizures so that we’re prepared to act calmly and efficiently and to seek medical help as appropriate.

Featured experts

Hamad Husainy, DO, FACEP, a practicing emergency physician in Alabama and a spokesperson for the American College of Emergency Physicians (ACEP).

Ashlesha Kaushik, MD, FAAP is an American Academy of Pediatrics (AAP) national spokesperson, pediatric infectious disease specialist and Clinical Assistant Professor of Pediatrics at the University of Iowa.

Sources

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Sawires R, Buttery J, Fahey M. A Review of Febrile Seizures: Recent Advances in Understanding of Febrile Seizure Pathophysiology and Commonly Implicated Viral Triggers. Front Pediatr. 2022;9:801321. Published 2022 Jan 13. doi:10.3389/fped.2021.801321

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