What is Febrile Seizure? Symptoms, Causes, & Treatment

A febrile seizure is a convulsion that happens when a child's body temperature rises quickly, usually during a fever. These seizures are surprisingly common and affect about 1 in 25 children between 6 months and 5 years old. While seeing your child have a seizure can be absolutely terrifying, most febrile seizures are harmless and don't cause any lasting problems.

What is a febrile seizure?

A febrile seizure occurs when your child's brain temporarily misfires due to a rapid spike in body temperature. Think of it like a circuit breaker that trips when there's too much electrical activity. The developing brain in young children is more sensitive to temperature changes, which explains why these seizures typically happen before age 6.

These seizures usually last between 30 seconds to 2 minutes, though they can feel much longer when you're watching. Your child might stiffen up, jerk their arms and legs, roll their eyes back, or briefly lose consciousness. Most children recover completely within minutes and act normally afterward.

What are the symptoms of febrile seizures?

The symptoms can vary depending on the type of febrile seizure your child experiences. Most parents describe feeling helpless and scared when they first witness these signs, which is completely understandable.

Simple febrile seizures (the most common type) typically show these signs:

• Full-body stiffening followed by jerking movements
• Loss of consciousness for 1-2 minutes
• Eyes rolling back or staring blankly
• Brief confusion or sleepiness afterward
• No lasting weakness or problems

Complex febrile seizures are less common but more concerning:

• Seizure lasting longer than 15 minutes
• Affecting only one part of the body
• Happening more than once in 24 hours
• Taking longer to recover normal alertness

After any febrile seizure, your child might seem tired, confused, or cranky for about 30 minutes. This is normal and doesn't mean anything is wrong with their brain.

What are the types of febrile seizures?

Doctors classify febrile seizures into two main types based on how they look and how long they last. Understanding these differences can help you know what to expect and when to seek immediate care.

Simple febrile seizures make up about 85% of all cases. They're called "simple" because they follow a predictable pattern and rarely cause complications. These seizures affect the whole body, last less than 15 minutes, and don't repeat within 24 hours.

Complex febrile seizures are less common but require more attention. They either last longer than 15 minutes, affect only one side of the body, or happen multiple times in one day. While still generally safe, complex seizures have a slightly higher chance of leading to future seizure problems.

What causes febrile seizures?

The main trigger is a rapid rise in your child's body temperature, usually when fever climbs quickly from normal to 101°F (38.3°C) or higher. It's not necessarily the height of the fever that matters, but how fast it rises.

Common illnesses that can trigger febrile seizures include:

• Viral infections like cold, flu, or roseola
• Ear infections
• Throat infections
• Stomach flu
• Pneumonia
• Urinary tract infections

Sometimes vaccines can cause fever that leads to seizures, particularly the MMR (measles, mumps, rubella) vaccine. This happens in about 1 in 3,000 to 4,000 children and usually occurs 8-14 days after vaccination.

In rare cases, more serious infections like meningitis or encephalitis can cause febrile seizures. However, these conditions typically come with additional warning signs like severe headache, neck stiffness, or extreme lethargy.

When should you see a doctor for febrile seizures?

Call 911 immediately if your child is having their first seizure, if it lasts longer than 5 minutes, or if they're having trouble breathing. Even though most febrile seizures are harmless, you need medical evaluation to rule out serious causes.

Seek emergency care right away if your child shows these signs:

• Seizure lasting more than 5 minutes
• Difficulty breathing or blue lips
• Severe drowsiness after the seizure ends
• Neck stiffness or severe headache
• Vomiting repeatedly
• Signs of dehydration

Contact your pediatrician within 24 hours for any febrile seizure, even if your child seems fine afterward. They'll want to examine your child and determine what's causing the fever.

For future febrile seizures in children who've had them before, you typically don't need emergency care unless the seizure is longer than usual or your child seems sicker than previous times.

What are the risk factors for febrile seizures?

Several factors can make your child more likely to experience febrile seizures. Understanding these risk factors can help you stay prepared, though remember that many children with risk factors never have seizures.

The most significant risk factors include:

• Age between 6 months and 5 years (peak risk is 12-18 months)
• Family history of febrile seizures in parents or siblings
• Previous febrile seizure
• Attending daycare (higher exposure to infections)
• Developmental delays
• Being born prematurely

Having a family history is particularly important. If you or your partner had febrile seizures as children, your child has about a 25% chance of having them too. If both parents had febrile seizures, the risk jumps to about 50%.

Children who have their first febrile seizure before age 1 or those with complex febrile seizures are more likely to have additional seizures in the future.

What are the possible complications of febrile seizures?

The good news is that febrile seizures rarely cause lasting problems or brain damage. Most children who have febrile seizures grow up completely normally with no effects on their learning, behavior, or development.

However, there are some potential concerns to be aware of:

• Risk of injury during the seizure from falling or hitting objects
• Slight increase in risk of future epilepsy (about 2-5% vs 1% in general population)
• Recurrence of febrile seizures with future fevers
• Temporary memory problems or confusion after complex seizures
• Parental anxiety about future fevers and illness

The risk of developing epilepsy is slightly higher if your child has complex febrile seizures, a family history of epilepsy, or developmental delays. Even then, the vast majority of children never develop ongoing seizure problems.

In extremely rare cases, very prolonged febrile seizures (lasting over 30 minutes) might cause some brain changes, but this is uncommon with proper medical care.

How can febrile seizures be prevented?

Unfortunately, you can't completely prevent febrile seizures since they're triggered by your child's natural response to infection. However, you can take steps to reduce fever and potentially lower the risk.

When your child has a fever, these strategies may help:

• Give fever-reducing medications like acetaminophen or ibuprofen as directed
• Keep your child well-hydrated with plenty of fluids
• Dress them in light clothing
• Use lukewarm baths or sponge baths (avoid ice or alcohol)
• Keep the room temperature comfortable
• Monitor temperature regularly

Keep in mind that preventing fever doesn't guarantee preventing seizures, since the seizure often happens as the fever is rising, sometimes before you even realize your child is getting sick.

Some doctors might prescribe preventive anti-seizure medication for children with frequent complex febrile seizures, but this is rarely necessary and comes with its own risks and side effects.

How are febrile seizures diagnosed?

Diagnosis starts with you describing exactly what happened during the seizure. Your doctor will want to know how long it lasted, what your child looked like, and how they acted afterward.

The physical examination focuses on finding the source of fever and checking for signs of serious infection. Your doctor will look for ear infections, throat infections, or other common causes of fever in children.

Additional tests might include:

• Blood tests to check for infection or other problems
• Urine tests to rule out urinary tract infections
• Chest X-ray if pneumonia is suspected
• Lumbar puncture (spinal tap) in rare cases if meningitis is suspected

For simple febrile seizures in children over 18 months, extensive testing usually isn't needed. The focus is on treating the underlying infection causing the fever.

EEG (brain wave test) and brain imaging are typically not necessary unless your child has complex febrile seizures or other concerning symptoms.

What is the treatment for febrile seizures?

Most febrile seizures stop on their own within a few minutes and don't require specific seizure treatment. The main focus is treating the underlying infection and keeping your child comfortable.

During a seizure, the most important thing is keeping your child safe. Turn them on their side, clear the area of hard objects, and never put anything in their mouth. Time the seizure and stay calm, even though it's frightening.

After the seizure, treatment typically includes:

• Fever-reducing medications (acetaminophen or ibuprofen)
• Antibiotics if bacterial infection is found
• Plenty of fluids and rest
• Close monitoring for additional seizures
• Treatment of the underlying illness causing fever

For children with frequent complex febrile seizures, doctors might consider preventive medications, but this decision requires careful consideration of benefits versus risks.

Emergency medications like rectal diazepam might be prescribed for children with prolonged seizures, though this is uncommon.

How to provide home care during febrile seizures?

Knowing how to respond during and after a febrile seizure can help you stay calmer and keep your child safer. Most of your care will focus on managing fever and watching for signs of the underlying illness.

During a seizure, remember these steps:

• Stay calm and time the seizure
• Turn your child on their side to prevent choking
• Remove hard objects from the area
• Never put anything in their mouth
• Don't try to hold them down or stop the movements
• Call 911 if it's the first seizure or lasts over 5 minutes

After the seizure ends, focus on comfort and fever management. Give fever-reducing medication as directed, offer small sips of fluid, and let your child rest. Keep the room cool and comfortable.

Watch for signs that require immediate medical attention, such as difficulty breathing, extreme sleepiness, or repeated vomiting. Most children will be back to their normal selves within an hour.

How should you prepare for your doctor appointment?

Being prepared for your doctor visit can help ensure you get the information and care your child needs. Write down your observations while they're fresh in your memory.

Before your appointment, gather this information:

• Exact time and duration of the seizure
• Description of what the seizure looked like
• Your child's temperature before, during, and after
• How your child acted before and after the seizure
• Any medications given and when
• Family history of febrile seizures or epilepsy

Bring a list of questions you want to ask, such as what to expect if another seizure happens, when to call the doctor, or how to best manage future fevers.

If possible, bring any medications your child is currently taking and their vaccination record. This information helps your doctor make the best treatment decisions.

What's the key takeaway about febrile seizures?

Febrile seizures are frightening to witness but rarely harmful to your child's long-term health and development. They're a common childhood experience that most children outgrow completely by age 6.

While you can't prevent all febrile seizures, managing fever promptly and knowing how to respond during a seizure can help keep your child safe. Most children who have febrile seizures grow up with no lasting effects.

Remember that having febrile seizures doesn't mean your child has epilepsy or will have learning problems. With proper medical care and your loving support, your child can continue to thrive and develop normally.

Trust your instincts as a parent. If something seems different or concerning about your child's seizures or recovery, don't hesitate to contact your healthcare provider for guidance and reassurance.