Immediate Management of Toddler Febrile Seizures
The immediate management of a toddler experiencing a febrile seizure should focus on positioning the child in a recovery position to prevent aspiration, clearing the area around them, and providing supportive care rather than administering anticonvulsant medications, as most febrile seizures are self-limiting and benign. 1
Initial Assessment and Management
- Place the child in a recovery position (on their side) to prevent aspiration and clear the area around them to prevent injury 1
- Do not attempt to restrain the child or put anything in their mouth 1
- Monitor airway, breathing, and circulation 2
- For seizures lasting more than 5 minutes, administer a benzodiazepine (such as rectal diazepam solution) 3, 4
- After the seizure, assess the child for signs of meningitis or encephalitis, which would require immediate medical attention 5
Temperature Management
- Once the seizure has stopped, administer antipyretics (such as acetaminophen or ibuprofen) for the child's comfort and to prevent dehydration, not to prevent future seizures 1, 2
- Use gradual passive cooling methods; avoid rapid cooling techniques like alcohol rubs as they may induce shivering and further elevate temperature 2
- Rectal forms of antipyretics are preferred during the acute phase, with oral forms given after the child has stopped seizing and is not vomiting 2
Diagnostic Evaluation
- For a well-appearing child with a simple febrile seizure (lasting <15 minutes, generalized, occurring once in 24 hours), routine diagnostic testing is not required 3
- For complex febrile seizures (lasting >15 minutes, focal, or recurrent within 24 hours), the neurologic examination should guide further evaluation 3
- Lumbar puncture is indicated in children with:
When to Activate Emergency Services
- First-time seizure 1
- Seizure in a child under 6 months 1
- Seizure lasting more than 5 minutes 1
- Repeated seizures without return to baseline 1
- Seizure with traumatic injury or respiratory difficulty 1
Parent Education
- Reassure parents about the benign nature of febrile seizures and their excellent prognosis 3, 2
- Explain that febrile seizures affect 2-5% of children with peak incidence around 18 months of age 6
- Inform parents that the risk of recurrence is approximately 30% in general, increasing to 50% in children under 12 months 6, 7
- Educate parents that simple febrile seizures do not cause brain damage, affect intelligence, or lead to learning disabilities 6
- Provide guidance on home management of seizures, including when to seek emergency care 3
Long-term Management Considerations
- Continuous or intermittent anticonvulsant therapy is not recommended for children with simple febrile seizures due to potential adverse effects 8, 6
- For children with high risk of prolonged febrile seizures (age <12 months, history of previous febrile status epilepticus, focal seizures, abnormal development/neurological exam, or family history of nonfebrile seizures), a rescue medication may be considered 5
- Follow-up with a primary care physician after a febrile seizure is recommended for parental reassurance and education 5