From the Guidelines
Febrile convulsions are generally benign and self-limiting, and most children do not require anticonvulsant medication, as the potential toxicities associated with these drugs outweigh the relatively minor risks associated with simple febrile seizures. When a child experiences a febrile convulsion, focus on keeping them safe by placing them on their side on a flat surface away from harmful objects. Do not restrain them or put anything in their mouth. After the seizure, administer paracetamol (acetaminophen) at 15mg/kg every 4-6 hours or ibuprofen at 10mg/kg every 6-8 hours to reduce fever, as fever treatment can help children feel better, although it will not prevent subsequent seizures 1. Ensure adequate hydration with frequent small amounts of fluid.
Some key points to consider when managing febrile convulsions include:
- Most febrile convulsions last less than 15 minutes and do not require anticonvulsant medication
- Antipyretics may improve the comfort of the child but will not prevent febrile seizures 1
- The risk of developing epilepsy in children with simple febrile seizures is extremely low, although slightly higher than that in the general population 1
- Seek immediate medical attention if the seizure lasts longer than 5 minutes, occurs repeatedly, or if the child doesn't fully recover afterward, as seizures lasting >5 minutes may not stop spontaneously and may need emergency medical intervention 1
In terms of long-term management, the committee concluded that neither continuous nor intermittent anticonvulsant therapy is recommended for children with 1 or more simple febrile seizures, due to the potential toxicities associated with these agents 1. However, in situations where parental anxiety associated with febrile seizures is severe, intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence 1.
From the Research
Definition and Characteristics of Febrile Convulsion
- Febrile convulsion is characterized by convulsion associated with fever in an infant or child aged between six months and six years 2.
- The febrile illness causing the convulsion should not be secondary to an intracranial infection (meningitis or encephalitis) or acute electrolyte imbalance 2.
- Most cases of febrile convulsion are short-lived and self-terminating 2.
Diagnosis and Management
- Diagnosis is based mainly on history taking, and further investigations into the condition are not generally needed in fully immunised children presenting with simple febrile convulsions 3.
- Management is mainly symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion 2.
- Treatment involves symptom control and treating the cause of the fever 3.
- Referral to paediatric neurologists may be necessary in cases of complex or recurrent febrile convulsion, or in those where a pre-existing neurological disorder exists 2.
Prevention and Prophylaxis
- Rectal diazepam can be used for the prevention of recurrent febrile convulsions, with therapeutic plasma levels attainable within 30 minutes and maintained for the first 24 hours 4.
- Selective episodic prophylactic home treatment with rectal diazepam in children with febrile convulsions can reduce the risks of permanent long-term anticonvulsive drug therapy 5.
- Prophylactic treatment with sodium valproate or phenobarbitone does not lessen the risk of recurrence and is associated with significant side-effects 6.
Prognosis and Recurrence
- One third of children will develop a further febrile convulsion during subsequent febrile illness 2.
- The long-term consequences of febrile convulsions are rare, but other causes of seizures, such as intracranial infections, must be excluded before diagnosis, especially in infants and younger children 3.