Summary

A Febrile Convulsion (Seizure) is an epileptic seizure occurring in a child aged 6 months to 5 years, associated with fever, without evidence of intracranial infection or defined cause. It is the most common seizure type in childhood, affecting 2-5% of children. Seizures are classified as Simple (Generalised tonic-clonic, <15 mins, Single) or Complex (Focal, >15 mins, Recurring in 24h). The prognosis is generally excellent with no increased risk of death or neurodevelopmental deficit. Management involves resuscitation (ABCDE) if actively seizing, identifying the source of fever, and parental reassurance. Long-term antiepileptic prophylaxis is NOT indicated.

Key Facts

• Definition: Seizure + Fever (Temp >38°C) in child 6m-5y, without CNS infection.
• Prevalence: 2-5% of all children.
• Peak Age: 18 months.
• Recurrence Risk: ~30% overall. Higher if younger age at onset.
• Epilepsy Risk: ~2-5% (Simple) vs ~10% (Complex). General population risk is 1%.
• Management: Rectal/Buccal benzodiazepine if >5 mins. NO routine AEDs.

Clinical Pearls

"It looks worse than it is": Parents often think their child has died. The seizure is terrifying to witness (cyanosis, frothing, shaking) but rarely harmful. Parental anxiety management is the primary treatment.

"Antipyretics don't prevent seizures": Giving Paracetamol/Ibuprofen treats the fever and distress, but does NOT prevent the seizure from happening or recurring. (RCT evidence).

"Watch the age limits": A "febrile seizure" in a 3-month-old is MENINGITIS until proven otherwise. A "febrile seizure" in a 7-year-old is likely epilepsy triggered by fever.

Simple vs Complex

Distinction is critical for prognosis and investigation.

Febrile Status Epilepticus

• Febrile seizure lasting > 30 minutes.
• Accounts for 5% of all cases.
• Medical emergency.

           CHILD SEIZING + FEVER
                     ↓
        ASSESS SAFETY (ABCDE)
        - Airway (Position lateral/Suction)
        - High Flow Oxygen
                     ↓
          TIME THE SEIZURE
             < 5 Minutes?            > 5 Minutes?
                 ↓                         ↓
           SUPPORTIVE CARE           ACUTE TREATMENT
           - Do NOT restrain         - Benzodiazepine
           - Cool environment        - Call for help
                     ↓
           POST-ICTAL PHASE
           - Treat Fever (Paracetamol/Ibuprofen)
           - Find Source (Ears/Throat/Urine)
           - Observation

1. Acute Management (Seizure > 5 mins)

Follow APLS (Advanced Paediatric Life Support) guidelines.

1. Buccal Midazolam: 0.5mg/kg.
   • 6m-1y: 2.5mg.
   • 1y-5y: 5mg.
   • 5y-10y: 7.5mg.
2. Rectal Diazepam: If Midazolam unavailable.
3. IV Lorazepam: 0.1mg/kg (If IV access obtained).

2. Post-Seizure Management

• Observe: Until GCS 15/15.
• Antipyretics: Paracetamol 15mg/kg / Ibuprofen 10mg/kg for comfort.
• Antibiotics: Only if bacterial source identified (e.g. Otitis Media, UTI).

3. Prevention (Prophylaxis)

• Continuous prophylaxis (Daily AEDs): NOT RECOMMENDED. Side effects (behaviour/sedation) outweigh risk of benign seizures.
• Intermittent prophylaxis (Home Rescue):
  • Prescribe Buccal Midazolam for home use IF:
    • History of prolonged seizures (>5 min).
    • Cluster seizures.
    • Live remotely (>30 mins from ambulance).

"Will my child be epileptic?" This is the parents' #1 question.

• Baseline Risk: 1 in 100 (1%) of general population develop epilepsy.
• Simple Febrile Seizure: Risk rises to 2% (Barely increased).
• Complex Febrile Seizure: Risk rises to 5-10%.
• Risk Factors for Epilepsy:
  1. Neurodevelopmental abnormality (Cerebral palsy).
  2. Complex febrile seizure.
  3. Family history of Epilepsy (Not just febrile Sz).
  4. Short fever duration before seizure (<1 hour) - suggests low threshold.

The "Grey Area". When to LP a febrile seizing child?

• AAP Guidelines (American Academy of Pediatrics):
  • Definitely: Meningeal signs.
  • Strongly Consider: Infants 6-12 months unimmunised for Hib/Pneumococcus.
  • Consider: Patients on prior antibiotics (masks signs).
• Clinical Reality: If the child wakes up, looks well, interacts, and has no neck stiffness -> LP usually not done. If child remains drowsy/irritable -> LP mandatory.

"Fever Phobia". Parents often become obsessed with measuring temperature after a seizure.

• Educate:
  • "Seizures can happen at 38°C or 40°C. Only the speed of rise matters."
  • "Giving Calpol will make them feel better, but scientific studies show it does not stop the fit."
  • "Put them in the recovery position. Time it. Do not put a spoon in their mouth."
  • "Call ambulance if: >5 mins, or one side shaking, or not waking up."

Key Guidelines

• NICE NG143 (Fever in under 5s): Traffic light system for assessing risk.
• APLS: Status Epilepticus algorithm.

Key Reviews

• Cochrane: Antipyretics for preventing febrile seizure recurrence.
  • Result: No significant reduction in seizure recurrence vs placebo.

What happened?

Your child had a "Febrile Convulsion". This is a seizure triggered by a rapid rise in body temperature (fever). It happens because young brains are sensitive to heat. It is very common (1 in 20 children).

Did it damage their brain?

No. Simple febrile seizures are frightening but harmless. They do not cause brain damage, blindness, or learning difficulties.

Will it happen again?

It might. About 1 in 3 children will have another one with a future illness. This becomes less likely as they get older, and usually stops completely by age 6.

Does this mean they have Epilepsy?

No. Epilepsy is when seizures happen without a fever. Most children grow out of febrile seizures and never have a seizure again.

What should I do next time?

1. Safety: Place them on their side on a soft surface.
2. Time it.
3. Do not panic: It usually stops in 2-3 minutes.
4. Call 999 if: It lasts more than 5 minutes, or they don't wake up.