Febrile seizures

Also called Febrile convulsions, Fever fits

A fit during a fever in a young child. Terrifying to watch, almost always harmless, and not epilepsy.

What it is

A seizure occurring during a fever in a child between roughly six months and five years, with no infection of the brain and no other cause.

They affect around one in 20 children, which makes them common, and they run in families.

They are frightening beyond description for anybody watching, and the single most useful thing is to know in advance what they are: a normal immature brain responding to a rapid rise in temperature. They are not epilepsy, they do not cause brain damage, and they do not affect intelligence or development.

Around a third of children who have one will have another, usually within a year.

The risk of later epilepsy is only slightly above the background population risk after a simple febrile seizure. It is somewhat higher after complex ones, meaning those lasting more than 15 minutes, affecting one side, or recurring within the same illness.

Antipyretics such as paracetamol and ibuprofen make a feverish child more comfortable but have not been shown to prevent febrile seizures, which is worth knowing so parents do not blame themselves for a missed dose.

The important task during one is not stopping the seizure but checking why the child has a fever, and excluding meningitis and encephalitis.

Signs you might notice

A fever, often noticed only when the seizure happens.

Stiffening, then rhythmic jerking of the arms and legs.

Loss of consciousness, eyes rolling back.

Sometimes wetting, vomiting, or a brief pause in breathing with blue lips.

Usually lasting under five minutes, followed by sleepiness or irritability for an hour or so.

999 immediately if: it is the first seizure; it lasts more than five minutes; the child is under one; breathing is difficult or lips stay blue afterwards; the child does not wake up properly; there is a rash that does not fade under a glass; the neck is stiff; or the child had another seizure in the same illness.

Always seek assessment after a first febrile seizure to find the source of the fever.

How it can affect day-to-day life

Parents describe thinking their child was dying. That reaction is universal and deserves acknowledging rather than correcting.

The most valuable intervention is a clear, written explanation of what to do next time, given before there is a next time. Families who have it cope far better.

For recurrent febrile seizures, some children are prescribed rescue medication, usually buccal midazolam, with a written plan. Schools and nurseries need training and a care plan.

Over-treating fever in an attempt to prevent seizures leads to unnecessary medication and anxiety; comfort is the aim.

Immunisations can cause fever and occasionally a febrile seizure. That is not a reason to avoid them, and it is worth saying, because vaccine hesitancy after a seizure is common.

Supporting someone well

During a seizure: note the time, stay calm, put the child on their side on a soft surface, remove anything hard nearby, loosen tight clothing, and do not restrain them.

Do not put anything in their mouth. Do not put them in a bath or use cold water.

Time it. Five minutes is the threshold for calling 999.

Call 999 for a first seizure, or for any of the danger signs above.

Afterwards, let the child sleep, and get the source of the fever checked.

Treat fever for comfort, not to prevent seizures.

Ask for a written plan, and if rescue medication is prescribed, make sure nursery or school are trained.

Keep immunisations up to date.

Where to get help

999 for a first seizure, a prolonged one, or any danger sign.

A GP practice or NHS 111 after a brief, typical seizure in a child already known to have them, to identify the cause of the fever.

Epilepsy Action helpline: 0808 800 5050, who cover febrile seizures and can explain the difference from epilepsy.