How to treat febrile seizures

I was nursing my feverish 13-month-old, when he stopped eating and appeared to be staring intensely out the window. At first, I thought he saw something of interest, but then I noticed that I couldn’t break his stare. He didn’t respond to his name or to distraction. When he started making strange noises and drooling, I knew something was wrong. 

Because I had worked in a daycare with several children who had a history of febrile seizures, I knew how to recognize one, and what to do. Having this information helped me stay calm during this very scary incident. 

Fortunately, as frightening as they look, febrile seizures are rarely dangerous and usually, children outgrow them. My son is now 11 years old, seizure-free, and has no lasting effects from the febrile seizures he had as a child. Here’s what you need to know about them.

What is a febrile seizure?

Febrile seizures (also called febrile convulsions) are the most common of early childhood seizures. In fact, 2% to 5% of children aged 6 months to 5 years experience febrile seizures. They are usually short in duration, generally lasting less than one to two minutes, and rarely more than five minutes. There are two types of febrile seizures.  Simple febrile seizures are the most common, and last less than 15 minutes. Complex febrile seizures are ones that last longer than 15 minutes, recur within a 24 hour period, or have concerning features like focal onset. 

What causes febrile seizures?

Febrile seizures occur when a child has a fever. While they can occur with a low-grade fever (100.4 degrees F), they usually happen when the child’s temperature is higher than 102 degrees F. They can also be associated with a rapidly changing body temperature—usually, one that is rising quickly, but occasionally when a child’s fever is dropping. 

Febrile seizures can occur with any illness and happen on the first day of a fever. Some illnesses commonly associated with febrile seizures include colds, the flu, roseola, pneumonia, and meningitis. 

Why do fevers lead to seizures in some young children? “It is unknown,” says Maryanne Tranter, Ph.D., APN, founder of The Healthy Child Concierge. “But a fever alters brain functions and chemistry. This influences brain neuron firing and excitability, which leads to seizures. Genetics influences these pathways. Environmental triggers are also believed to be involved.” Meaning, a family history of febrile seizures could indicate a higher risk.

Who is at risk for febrile seizures?

Any children between 6 months and 5 years of age can have febrile seizures, most frequently between 14 to 18 months of age. They occur more in boys than in girls and have a slight tendency to be hereditary.

About one third of children who have had one febrile seizure will have at least one more during their childhood.

What are the symptoms of a febrile seizure?

Symptoms may include fever plus one or more of the following:

• Staring
• Severe shaking
• Jerking on one or both sides
• Tightening of the muscles on one or both sides
• Limpness of the muscles on one or both sides
• Loss of consciousness
• Breathing difficulty
• Foaming at the mouth
• Pale or blue skin
• Eye rolling

How long do febrile seizures last?

Simple febrile seizures usually last only a few minutes—five minutes or less. Occasionally they last more than five minutes and rarely more than 15 minutes. Complex febrile seizures may last more than 15 minutes and can occur more than once in a 24-hour period.

How is a febrile seizure diagnosed?

With simple febrile seizures, healthcare providers focus on the illness that is the cause of the fever. They may run blood tests, do X-rays, or use other diagnostic tools to identify the infection or virus responsible for making the child sick. 

For complex febrile seizures, they may order an EEG for the child and/or make a referral to a specialist such as a neurologist.

If someone else is present, it is helpful if they record the seizure, suggests Uchenna L. Umeh, MD, aka Dr. Lulu of Dr. Lulu’s Health Center in San Antonio, Texas. This footage allows the doctor to see the seizure and make a more accurate diagnosis than a verbal description.

What to do when a child is having a febrile seizure

During the seizure 

First and foremost, it’s important that you stay calm. Here’s what else you should do to ensure your child stays safe.

1. Lay the child on his or her side on the floor and remove any nearby objects.
2. Do NOT put anything in the child’s mouth, including your fingers. It is impossible for a person having a seizure to swallow his or her tongue.
3. Do not try to restrain the child.
4. Remove any tight clothing, especially around the neck.
5. Time the duration of the seizure.

Call 911 if any of the following occurs:

• The seizure lasts longer than five minutes.
• The seizure affects only one side.
• The child is having breathing difficulties or turning blue.
• The child has multiple seizures.
• There is vomiting accompanying the seizure.
• The child has a stiff neck.
• If you feel it is necessary.
• The child has extreme sleepiness

If you aren’t sure if you should call, call—particularly if this is the child’s first febrile seizure.

After the seizure

When the seizure has passed, reassure, comfort, and monitor your child. He or she may feel drowsy or confused after the seizure, but should be acting normally within an hour. 

Next, make an appointment with the pediatrician. This is important not only because of the seizure, but to diagnose and treat the illness that caused it. 

Febrile seizure treatment

Usually, febrile seizures don’t require treatment other than for the underlying illness accompanying them. Sometimes diazepam gel is used to treat recurring febrile seizures.  If the seizure is complex, a benzodiazepine such as Midazolam may be administered by the emergency room staff, but this is rare.

RELATED: People with epilepsy now have a nasal spray option for fast-acting seizure treatment

Are febrile seizures dangerous?

Because they are scary-looking, parents often worry that febrile seizures could be immediately dangerous or cause lasting side effects, such a brain damage. The good news is that febrile seizures are almost always harmless.

Febrile seizures do not cause epilepsy. After a febrile seizure, a child’s risk for developing a seizure disorder rises to 2% to 4%, which is slightly higher than the average; but it is a correlation, not a cause. 

A prolonged seizure that lasts longer than five to 15 minutes may result in  an increased risk of epilepsy, but that is very rare. “Any kind of convulsive episode is potentially dangerous,” says Dr. Umeh. “The longer it lasts, the more dangerous. But febrile seizures generally don’t last too long.”

Children almost always outgrow febrile seizures by age 5 or 6.

Can febrile seizures be prevented?

While doctors sometimes suggest using fever reducers such as ibuprofen and acetaminophen as preventative measures for febrile seizures, there is little scientific evidence to show they are effective for that purpose. “Using medicines such as acetaminophen or ibuprofen for fevers has repeatedly been shown that they do not prevent febrile seizures,” says Dr. Tranter. They are effective at reducing fevers, which may help your child feel more comfortable. Following the treatment plan from your child’s doctor will help with recovery, reducing the risk of another seizure with the current illness.

The best way to prevent febrile seizures is to prevent illnesses in the first place. “Handwashing, covering mouths with coughs, getting enough sleep to keep immune function strong, and getting a flu vaccine, which can prevent the flu or decrease the severity of symptoms if you do get the flu” are some measures Dr. Tranter suggests to reduce catching and spreading illnesses that could lead to febrile seizures.

It never hurts to be prepared. Knowing the signs of a febrile seizure and what to do if your child has one won’t prevent one. But, first aid training helps keep parents calm and promotes a quick and accurate response.

“Caregivers can take a cardiopulmonary resuscitation class, which may help decrease their fear and anxiety if it happens again,” says Dr. Tranter.

Febrile seizures look scary—but if your child has one, try not to worry. They are almost always harmless, and resolve on their own.