Understanding Febrile Seizures: A Pediatric Perspective

What are febrile seizures?

Febrile seizures are seizures triggered by a fever greater than or equal to 100.4° F (38° C), and are a common cause of seizures in children between the ages of 6 months and 5 years. They typically occur when a child has an illness such as the flu, chickenpox, measles, RSV (respiratory syncytial virus), or an ear infection. Febrile seizures can be a very alarming experience for parents and caregivers, but they are a very common occurrence in infants and young children. Understanding the nature of febrile seizures, why they occur, and how to respond can reduce anxiety and ensure proper care for the child. 

Causes and risk factors of febrile seizures

Febrile seizures result from the way a child’s body responds to elevated body temperature and are unlikely to result from the illness itself. The causes of febrile seizures include a combination of genetic and environmental factors that affect a child’s developing nervous system during fever. Common triggers include viral infections (influenza, adenovirus, parainfluenza, roseola infantum) and ear infections (otitis media). These infections are associated with high fevers and can increase the risk of febrile seizures, as fever can make the brain more excitable and lower the seizure threshold. 

Some children are more likely to have febrile seizures due to their genetics, especially if they have first or second-degree relatives with a history of febrile seizures or epilepsy in childhood. Additional risk factors for children include underlying genetic disorders, prenatal exposure to maternal smoking or stress, and prolonged stays in the neonatal intensive care unit. 

Certain vaccines, like the MMR vaccine (measles, mumps, rubella), have been associated with a slightly increased risk of febrile seizures. However, this risk remains low and can be minimized by following recommended immunization schedules to prevent serious infections in children. 

Physical signs and symptoms of febrile seizures

During a febrile seizure, a child may present with:

• Loss of consciousness

• Uncontrolled shaking of the body and extremities 

• Stiff or rigid posture

• Eye rolling or fixed gaze

• Irregular breathing

• Loss of voluntary control (vomiting, drooling, urinating)

Simple febrile seizures are the most common type of febrile seizure. They last less than 15 minutes, do not recur within a 24-hour period, and involve whole-body convulsions. 

Complex febrile seizures are less common and may require further medical evaluation. They last longer than 15 minutes, may recur within 24 hours, or affect only one part of the body. Although most children will recover fully from complex febrile seizures, these seizures are associated with a higher risk of recurrence and a small increased risk of other findings affecting the brain or nervous system. 

How to respond in the event of a febrile seizure

If the child is having a febrile seizure, the priority is to remain calm, carefully observe the child and let the seizure pass. During a febrile seizure, parents and caregivers should protect the child from injury by:

• Placing the child on their side on the floor 

• Removing nearby objects that can cause injury

• Loosening any tight clothing, especially around the neck

• Avoiding placing objects in the mouth 

• Avoiding restraining or holding the child during the seizure

Seek emergency medical help or go to the ER if:

• The seizure lasts more than 5 minutes

• The child has difficulty breathing or turns blue

• It is the child’s first seizure

• The child has another seizure within 24 hours

• There are signs of meningitis, such as a stiff neck, unusual drowsiness, or persistent vomiting

• The child is unable to wake up or does not recover as expected

After the seizure, the child will normally look sleepy, confused, or tired. Parents and caregivers can observe the child’s breathing and responsiveness. Fluids and medications such as ibuprofen and acetaminophen can be given to reduce the fever and help the child feel comfortable. However, studies conclude that these fever-reducing medications do not prevent febrile seizures in children. 

Febrile seizures are a common and generally harmless response to fever in young children. Although they can be alarming, most are brief and do not lead to long-term problems. Understanding their causes and knowing how to respond can help caregivers manage them with confidence and ensure the child’s safety. 

References:

1. Smith, D. K., Sadler, K. P., & Benedum, M. (2019). Febrile seizures: Risks, evaluation, and prognosis. American Family Physician, 99(7), 445–450. https://www.aafp.org/afp/2019/0401/p445 

2. Eilbert, W., & Chan, C. (2024). Febrile seizures: A review. JACEP Open. https://doi.org/10.1002/emp2.12769 

3. National Institute of Neurological Disorders and Stroke. (n.d.). Febrile seizures. U.S. Department of Health and Human Services. https://www.ninds.nih.gov/health-information/disorders/febrile-seizures 

Assessed and Endorsed by the MedReport Medical Review Board