From the Guidelines
For a 15-month-old child with a new febrile seizure, a neurology consultation is typically not recommended as part of routine care. Simple febrile seizures are common in children between 6 months and 5 years of age and are generally benign with excellent prognosis, as stated in the 2008 clinical practice guideline for the long-term management of the child with simple febrile seizures 1. Management should focus on:
- Identifying and treating the underlying fever cause
- Providing antipyretics like acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours)
- Parent education about febrile seizures
However, neurological consultation should be considered if:
- The seizure lasted longer than 15 minutes
- Had focal features
- Occurred multiple times within 24 hours
- If the child has developmental delays, abnormal neurological examination, or a family history of epilepsy, as suggested by the 2021 ACR Appropriateness Criteria for seizures in children 1. Parents should be reassured that simple febrile seizures do not cause brain damage or developmental problems, and the risk of developing epilepsy is only slightly higher than the general population. Home management includes fever control, placing the child in recovery position during seizures, and avoiding putting anything in the child's mouth.
From the Research
Neurology Consult for a 15-month-old with a New Febrile Seizure
- A neurology consult is recommended for certain cases of febrile seizures, including those with prolonged or focal seizures, or those with abnormal neurological exams or development 2.
- For a 15-month-old with a new febrile seizure, the decision to request a neurology consult depends on the specific characteristics of the seizure and the child's overall health.
- According to the study by 2, a neurological consultation should be requested for any child who has experienced a prolonged FS before the age of 1 year, for children who have experienced prolonged and focal FS or repetitive (within 24h) focal FS, for children who have experienced multiple complex (focal or prolonged or repetitive) FS, for children with an abnormal neurological exam or abnormal development experiencing a FS.
- However, since the child in question is 15 months old and there is no mention of the seizure being prolonged, focal, or repetitive, or the child having an abnormal neurological exam or development, a neurology consult may not be immediately necessary.
- The American Academy of Pediatrics guidelines, as mentioned in 3, do not recommend routine lumbar puncture or neurology consult for simple febrile seizures in children over 12 months old, unless there are signs suggestive of meningitis or other underlying conditions.
- Other studies, such as 4 and 5, also suggest that simple febrile seizures in children over 12 months old do not typically require extensive evaluation or neurology consult, unless there are underlying risk factors or concerns.
- The study by 6 recommends hospitalization for 24 hours for monitoring, but does not necessarily recommend a neurology consult for infants over 7 months old with simple febrile seizures, unless there are other risk factors present.