What advice to give to parents of a child with fever and seizure?

Parental Advice for Febrile Seizures

Reassure parents that febrile seizures have an excellent prognosis with no long-term effects on brain development, intelligence, or academic performance, and provide clear instructions on immediate seizure management and when to seek emergency care. 1

Immediate Reassurance About Prognosis

• The developmental and neurological prognosis is excellent – febrile seizures do not cause brain damage, intellectual decline, learning disabilities, or behavioral problems. 1
• The risk of developing epilepsy after a simple febrile seizure is only about 2.5%, similar to the general population. 1
• While recurrence risk is approximately 30% overall (higher at 50% if the child is under 12 months at first seizure), these recurrent seizures remain benign. 1, 2
• Death during a simple febrile seizure has never been reported. 1

Home Management Instructions

During a seizure, parents should:

• Place the child on their side on the ground to prevent injury and reduce aspiration risk. 1, 2
• Clear the area around the child of any objects that could cause injury. 1
• Stay with the child throughout the seizure. 1
• Time the seizure duration. 1

Parents must NOT:

• Restrain the child during the seizure. 1
• Put anything in the child's mouth (no fingers, spoons, or other objects). 1, 2
• Give food, liquids, or oral medications during or immediately after the seizure while consciousness is impaired. 1
• Use cold baths, ice, alcohol rubs, or aggressive cooling methods. 1, 3

When to Call Emergency Services

Activate emergency medical services if: 1, 2

• The seizure lasts longer than 5 minutes
• Multiple seizures occur without the child returning to normal between episodes
• The child does not return to baseline mental status within 5-10 minutes after the seizure stops
• The seizure occurs in water
• There is difficulty breathing or choking
• The child sustains a traumatic injury during the seizure
• This is the first seizure ever (requires medical evaluation)

Fever Management

• Treat fever with acetaminophen (paracetamol) to promote comfort and prevent dehydration, not to prevent seizures. 1, 2
• Antipyretics do NOT prevent febrile seizure recurrence – this is a critical point to emphasize, as parents often believe fever control will prevent future seizures. 1, 2
• Ensure adequate fluid intake to prevent dehydration. 1
• Avoid physical cooling methods like tepid sponging, fanning, or cold bathing as these cause discomfort without proven benefit. 1

Follow-Up Care

• The child should be evaluated by a physician after the first febrile seizure to identify the source of fever and ensure appropriate treatment. 2, 4
• For children under 12 months, medical evaluation is particularly important as lumbar puncture is often indicated to rule out meningitis. 1, 2
• A follow-up visit with the primary care physician is recommended to address parental concerns and provide additional education. 4

Common Pitfalls to Avoid

Do not use continuous anticonvulsant medications – routine prophylactic anticonvulsant therapy is not recommended for simple febrile seizures due to adverse effects that outweigh benefits in this benign condition. 1, 2

Understand that fever height matters less than rapidity of rise – seizures are more likely when temperature rises quickly, even to a lower maximum, rather than slowly rising to a higher temperature. 3