AKT · Child health/Growth, GI & MSK

Febrile convulsions

Seizure with fever (age 6 months–5 years)

Overview

A seizure occurring with fever in a child 6 months–5 years WITHOUT CNS infection or a prior afebrile seizure. Simple febrile convulsions are benign; the priority is excluding meningitis/encephalitis.

Recognise

Simple: generalised tonic-clonic, <15 min, once in 24h, full recovery
Complex: focal, >15 min, or recurring within 24h
Occurs as temperature rises, age 6 months–5 years

Red flags

Meningitis/encephalitis features, focal/prolonged seizure, age 6 years, not returning to normal

Differentials & how to tell them apart

CNS infection (meningitis/encephalitis)the must-exclude — non-blanching rash, neck stiffness, drowsiness, not recovering

Epilepsyafebrile seizures; febrile convulsions slightly raise later epilepsy risk

Rigorsshivering without loss of consciousness/post-ictal phase

Reflex anoxic seizuretriggered by pain/fright, brief

Investigations

Identify the fever source clinically. Simple febrile convulsion needs no routine neuro-imaging/EEG/LP — but LOW threshold for LP/septic screen if any meningitis concern, especially <18 months or on antibiotics.

Management

Supportive; rescue benzodiazepine only if seizure >5 minutes

1Simple febrile convulsion: reassure, identify/treat fever source, safety-net advice. No routine investigations.Gate: Complex features, suspected CNS infection, or not returning to baseline → admit, septic screen ± LP
2Prolonged seizure (>5 min): buccal midazolam. Teach parents first aid and antipyretic comfort.

Antipyretics for comfort — do NOT prevent recurrence

Buccal midazolam / rectal diazepam — rescue for a prolonged seizure (>5 min)

Key points

Antipyretics do NOT prevent recurrence (a common misconception). Simple febrile convulsions carry only a small increase in later epilepsy risk.

Monitor & prognosis

Recovery to baseline; recurrence; development.

Excellent; most outgrow by 5 years.

Source: NICE CKS Febrile seizure