Seeing a feverish child suddenly stiffen, roll their eyes, and shake is frightening. Febrile seizures are relatively common in young children and usually have a good outlook, but knowing in advance when to seek emergency care can help you stay steady.
Why It Happens
A febrile seizure is a seizure that occurs with fever when there is no clear underlying brain illness or metabolic problem. The commonly given explanation is that a young, still-developing brain is prone to seizures when body temperature rises, and the fever is often from an ordinary infection such as a cold or ear infection. The seizure tends to happen early as the fever climbs, so some parents learn about the fever only when the seizure occurs. It is thought to be more common when a family member has had febrile seizures.
How It Differs by Age and Type
Febrile seizures typically occur between 6 months and 5 years of age. Clinicians divide them into simple and complex types. A simple febrile seizure involves the whole body, ends within 15 minutes, and has no focal features. A complex one lasts longer than 15 minutes, affects only one side of the body, or happens more than once in a day. Complex seizures often call for more evaluation to look for the cause.
Recurrence is common. A Cochrane summary says about 1 in 3 children with a febrile seizure will have at least one more, and published reviews cite 30-50%. In a Korean study of 125 children, 36 (28.8%) had a recurrence, with half occurring within 6 months and 72.2% within a year. Recurrence tends to be more likely when the first seizure happened before 12 months of age or a close relative had febrile seizures.
Care at Home
When a seizure begins, note the time. Lay your child on a flat, safe surface on the floor and move sharp objects away. Turn them onto their side so saliva or vomit does not reach the airway, and loosen clothing around the head and neck. KidsHealth advises not to hold or restrain the child, not to put anything in the mouth, and not to give fever medicine or use cool water during the seizure. Most febrile seizures stop within 5 minutes. Afterward your child may be sleepy or dazed, so stay close and watch breathing and alertness. A first seizure is generally advised to be checked by a doctor the same day to find the cause of the fever. Keeping your child comfortable during later fevers is reasonable, but fever medicine alone should not be assumed to prevent a seizure.
Common Misunderstandings
First, that a febrile seizure means epilepsy. For a previously healthy child, a simple febrile seizure is known to rarely lead to epilepsy. Second, putting a finger or spoon in the mouth so the child won’t bite their tongue; this can block the airway or cause injury and isn’t recommended. Third, that a higher fever always means a longer seizure; studies differ on how fever level relates to recurrence. Fourth, that one seizure leaves lasting damage. Most children recover to their usual selves afterward.
Signs That Need Emergency Care Right Away
KidsHealth advises calling 911 right away if a seizure lasts more than 5 minutes or if your child turns blue. Seek emergency care right away as well if your child has trouble breathing, if the seizure affects only part of the body, if they don’t wake up or respond normally afterward, or if another seizure occurs within 24 hours. A stiff neck, heavy vomiting, light sensitivity, or a bulging soft spot in a baby can signal meningitis and calls for the emergency room without delay. Even if the seizure stops within 5 minutes and your child wakes quickly, consider contacting your pediatrician the same day. This information reflects general guidance for the United States; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.