Immediate Management of Febrile Seizures in Children
Place the child in a recovery position to prevent aspiration, clear the surrounding area to prevent injury, and do not restrain the child or place anything in their mouth—most febrile seizures are self-limiting and will resolve spontaneously. 1
During the Active Seizure
- Position the child on their side (recovery position) to maintain airway patency and prevent aspiration of secretions 1
- Remove nearby objects that could cause injury during the seizure activity 1
- Do not attempt to restrain the child or hold them down, as this can cause injury 1
- Never place anything in the child's mouth, including fingers, spoons, or bite blocks—this is a dangerous practice that can cause harm 1
- Time the seizure duration carefully, as management changes significantly if it exceeds 5 minutes 1, 2
When to Administer Emergency Medication
- For seizures lasting more than 5 minutes, administer a benzodiazepine immediately to terminate the seizure 2
- Most febrile seizures are brief and self-limiting, resolving within 1-2 minutes without intervention 1
When to Activate Emergency Services
Call emergency services (911) if any of the following occur: 1
- This is the child's first-time seizure (requires evaluation to confirm diagnosis)
- The child is under 6 months of age (febrile seizures are not typical in this age group)
- The seizure lasts more than 5 minutes
- Repeated seizures occur without the child returning to baseline consciousness between episodes
- The seizure is associated with traumatic injury or respiratory difficulty
Post-Seizure Assessment
- After the seizure stops, assess for signs of meningitis (neck stiffness, altered consciousness, septic appearance, non-blanching rash) which would require immediate antibiotics 3, 4
- Evaluate the source of fever to guide appropriate treatment 2
- Reassess the child within 4 hours of the initial evaluation, particularly in infants under 12 months, to ensure no evolving signs of serious infection 4
What NOT to Do
- Do not routinely perform lumbar puncture for simple febrile seizures in well-appearing children without meningeal signs 4
- Do not prescribe continuous anticonvulsant therapy (phenobarbital, valproic acid) for simple febrile seizures due to adverse effects including fatal hepatotoxicity 5, 1
- Do not delay antibiotics for diagnostic procedures if bacterial meningitis is suspected based on clinical presentation 3
Parent Education at the Time of Event
- Reassure parents that simple febrile seizures do not cause brain damage, affect intelligence, or lead to learning disabilities 1
- Explain that febrile seizures affect 2-5% of children with peak incidence around 18 months 1
- Inform parents about the 30% general recurrence risk (50% if under 12 months at first seizure) 1
- Provide clear instructions on when to call emergency services for future episodes 1