In a febrile seizure, do you give oxygen or cool the body?

Management of Febrile Seizures: Oxygen vs. Cooling

For a child experiencing a febrile seizure, focus on preventing injury by positioning the child safely on their side and clearing the surrounding area—neither oxygen administration nor active body cooling is indicated during the seizure itself. 1

Immediate Management During the Seizure

Prioritize safety measures over interventions:

• Help the child to the ground and place them on their side in the recovery position to reduce aspiration risk 1
• Clear the area around the child to prevent injury from seizure movements 1
• Stay with the child throughout the seizure 1
• Do not restrain the child or place anything in their mouth 1

When to Consider Oxygen

Oxygen is not routinely indicated for febrile seizures unless specific complications develop:

• Administer supplemental oxygen only if the child shows signs of hypoxia (cyanosis, oxygen saturation <92%) or has difficulty breathing 1
• Most febrile seizures are brief (1-2 minutes) and self-limited, resolving before hypoxia develops 1, 2
• Monitor with pulse oximetry if available, but oxygen is not a first-line intervention 1

Body Cooling: Not Effective for Seizure Management

Antipyretics and active cooling do not stop an ongoing seizure or prevent subsequent febrile seizures 1:

• The 2024 American Heart Association guidelines explicitly state (Class 3: No Benefit, Level B-R) that antipyretics such as acetaminophen or ibuprofen are not effective for stopping a febrile seizure or preventing recurrence 1
• Two meta-analyses from 2021 demonstrated no benefit of fever treatment in preventing febrile seizures during the same illness or subsequent illnesses 1
• While fever treatment can help children feel more comfortable, it does not alter seizure risk 1

Post-Seizure Management

After the seizure stops:

• Allow the child to rest in the recovery position during the postictal period (confusion, tiredness lasting several minutes) 1
• Treat the underlying source of fever with antipyretics for comfort, but understand this does not prevent future seizures 1, 2
• Do not give oral medications or fluids until the child is fully alert 1

When to Activate Emergency Services

Call EMS immediately if: 1

• First-time seizure in any child
• Seizure lasting >5 minutes (may require benzodiazepine administration) 1, 2
• Multiple seizures without return to baseline between episodes
• Seizure in an infant <6 months of age
• Child does not return to baseline within 5-10 minutes after seizure stops
• Associated difficulty breathing, choking, or traumatic injury 1

Common Pitfalls to Avoid

Do not:

• Attempt active cooling during the seizure—this is ineffective and distracts from safety measures 1
• Administer oxygen routinely without evidence of respiratory compromise 1
• Give antipyretics expecting them to prevent seizure recurrence 1
• Place objects in the child's mouth or restrain them 1

Prognosis and Parent Education

Febrile seizures are benign with excellent long-term outcomes 2, 3:

• No increased mortality or negative effects on intellect, behavior, or academic progress 2
• Risk of developing epilepsy is only 2-3% after simple febrile seizures 2, 4
• Recurrence risk is approximately 30% overall (50% in children <1 year) 2, 3