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 1. When a child experiences a febrile convulsion, it is essential to 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. Tepid sponging may also help lower body temperature.
Some key points to consider when managing febrile convulsions include:
- Most febrile convulsions last less than 15 minutes and do not cause brain damage or lead to epilepsy 1.
- Seek immediate medical attention if the seizure lasts longer than 5 minutes, occurs repeatedly, or if the child doesn't fully recover afterward 1.
- Parents should be reassured that most children outgrow febrile convulsions by age 5-6 years without long-term consequences 1.
- Antipyretics may improve the comfort of the child, but they will not prevent febrile seizures 1.
- Intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence in situations where parental anxiety associated with febrile seizures is severe, but this should be weighed against the potential risks and benefits 1.
From the Research
Definition and Prevalence of Febrile Convulsion
- Febrile convulsions (FCs) are characterized by convulsions associated with fever in children aged between 6 months and 6 years 2, 3, 4.
- FCs are relatively common and affect 3-4% of children in western countries, making them the most common seizure disorder seen in children 2, 5.
Causes and Diagnosis of Febrile Convulsion
- The cause of febrile illness in FC is usually benign and most frequently due to acute viral infection 2, 3.
- Convulsions secondary to an intracranial infection (e.g. meningitis, encephalitis) or from acute electrolyte imbalance should not be labelled as FCs 2, 3, 4.
- Diagnosis is based mainly on clinical history, and further investigations are generally unnecessary 2, 3, 4.
Management and Treatment of Febrile Convulsion
- Management is largely symptomatic, although anticonvulsants may have a role in a small number of children with complex or recurrent febrile convulsion 2, 4.
- Prolonged FC may need anticonvulsant medication to stop the seizure 2, 4.
- Referral to paediatric neurologists may be considered in cases of complex or recurrent FC or in children where there is a pre-existing neurological disorder 2, 4.
Prognosis and Recurrence of Febrile Convulsion
- One third of children with a first FC will develop a further FC during subsequent febrile illness 2, 4, 5.
- The likelihood of recurrence increases in the presence of other risk factors 2.
- The prognosis is generally good, and affected children do not suffer any long-term health problems 5.