Are febrile seizures a normal response to fever in children?

Are Febrile Seizures Normal?

Yes, febrile seizures are a common, benign neurological response to fever in young children and should be considered a normal variant of childhood development rather than a pathological condition. 1

Understanding Febrile Seizures as a Benign Phenomenon

Febrile seizures affect 2-5% of all children between 6 and 60 months of age, making them the most common seizure disorder in childhood. 1, 2 This high prevalence supports their classification as a normal developmental response rather than a disease state. They occur in febrile children without intracranial infection, metabolic disturbance, or history of afebrile seizures. 1

Key Characteristics of Simple Febrile Seizures

Simple febrile seizures (the most common type) have the following features:

• Last less than 15 minutes 1
• Are generalized without focal neurological signs 1
• Occur only once within a 24-hour period 1
• Resolve spontaneously within 1-2 minutes in most cases 1

Excellent Long-Term Outcomes Support Their Benign Nature

The evidence overwhelmingly demonstrates that simple febrile seizures cause no long-term harm:

• No cognitive impact: No decline in IQ, academic performance, neurocognitive attention, or behavioral abnormalities results from recurrent simple febrile seizures 1, 2
• No structural brain damage: There is no evidence that simple febrile seizures cause structural damage to the brain 1
• Minimal epilepsy risk: Children with simple febrile seizures have approximately the same 1% risk of developing epilepsy by age 7 as the general population 1, 2
• No increased mortality: Death during a simple febrile seizure has never been documented 1

Even children with risk factors (multiple seizures, age <12 months at first seizure, family history of epilepsy) have only a 2.4% risk of developing epilepsy by age 25, and this is likely due to genetic predisposition rather than the seizures themselves. 1

Why Treatment Is NOT Recommended

The American Academy of Pediatrics explicitly recommends against both continuous and intermittent anticonvulsant therapy for children with simple febrile seizures. 1, 2 This recommendation exists because:

• The potential toxicities of anticonvulsants (including fatal hepatotoxicity and thrombocytopenia) outweigh the minimal risks of simple febrile seizures 2
• While medications like phenobarbital, primidone, valproic acid, and diazepam can reduce recurrence, they cannot prevent the development of epilepsy 1
• Antipyretics (acetaminophen, ibuprofen, paracetamol) are ineffective at preventing febrile seizures, though they may improve comfort 1

Recurrence Risk: The Only Significant Concern

The main "adverse outcome" is recurrence, which varies by age:

• Children <12 months at first seizure: 50% recurrence risk 1, 2
• Children >12 months at first seizure: 30% recurrence risk 1, 2
• Of those with a second seizure, 50% will have at least one additional recurrence 1

However, even recurrent simple febrile seizures remain benign and require no treatment. 1

When to Activate Emergency Services

While simple febrile seizures are benign, emergency medical services should be activated for: 1

• First-time seizure
• Seizure lasting >5 minutes
• Seizure in an infant <6 months
• Multiple seizures without return to baseline between episodes
• Failure to return to baseline within 5-10 minutes after seizure stops
• Seizure with traumatic injuries, choking, or difficulty breathing

Practical Management During a Seizure

First aid providers should: 1

• Help the child to the ground and place them on their side in recovery position
• Clear the area around the child to prevent injury
• Stay with the child
• Never restrain the child 1
• Never put anything in the child's mouth or give oral medications/food/liquids during or immediately after the seizure 1

Parent Education Is Critical

The most important intervention is educating parents about the benign nature of febrile seizures. 1 Parents should understand that while frightening to witness, simple febrile seizures do not harm their child's brain, intelligence, or future development. This reassurance is essential given that febrile seizures are "a terrifying experience for most parents." 3, 4