Febrile seizures: what they look like, what to do, and why most babies recover fully
What is a febrile seizure?
A febrile seizure is a convulsion triggered by a rapid rise in body temperature, usually during a viral illness. It is one of the most frightening things a parent can witness, but it is important to know from the outset that febrile seizures are common, and the overwhelming majority of children who have one recover completely with no lasting effects.
Febrile seizures are most common in children between 6 months and 5 years of age, with the peak around 18 months. According to the NHS and the AAP, approximately 1 in 30 children will have at least one febrile seizure. In most cases, the seizure occurs in the first few hours of an illness, often before you even knew your child had a significant fever.
What a febrile seizure looks like
During a typical (simple) febrile seizure, your child's body will stiffen suddenly. Their limbs will then begin to jerk rhythmically. Their eyes may roll upwards or to one side. Their skin may briefly look pale, blue, or mottled, particularly around the lips. They will be unresponsive during the seizure and will not be able to hear or respond to you. This is terrifying to watch, but the bluish colour (cyanosis) is caused by the breath holding that often accompanies the jerking movements, and it resolves as the seizure ends.
A simple febrile seizure usually lasts between 1 and 3 minutes and involves the whole body. It stops on its own. A complex febrile seizure lasts longer than 15 minutes, affects only one part of the body, or occurs more than once in a 24-hour period. Complex febrile seizures are less common and will be assessed more thoroughly by doctors.
What to do during a febrile seizure
If your child has a febrile seizure, here is exactly what to do.
Stay with your child and stay as calm as you can. Do not try to restrain their movements. Holding or pinning a child during a seizure does not stop the seizure and can cause injury. Do not put anything in your child's mouth, including your fingers. This is an outdated practice and it is dangerous: you can be bitten badly, and the child cannot swallow their tongue during a seizure despite what you may have heard.
Clear the immediate area of anything hard or sharp that your child could knock against. Place your child gently onto their side, into the recovery position, to keep their airway clear and allow any saliva or vomit to drain. Tilt their head back slightly to open the airway.
Note the time the seizure started. Timing the seizure is one of the most useful things you can do because the duration is important information for doctors and for deciding whether to call emergency services.
Call 999 if: this is the first time your child has had a febrile seizure; the seizure lasts longer than 5 minutes; your child does not begin to recover and become more responsive within 30 minutes of the seizure ending; your child has difficulty breathing after the seizure; or you are in any doubt at all. If your child has had febrile seizures before and the current one behaves like previous ones, lasting only 1 to 3 minutes and followed by normal recovery, you may call 111 for advice rather than 999, but only if you feel certain and comfortable doing so. When in doubt, call 999.
What happens after the seizure
After a febrile seizure your child will likely be drowsy, confused, and possibly distressed or frightened. This period is called the postictal phase, and it is completely normal. Your child may sleep deeply, be unsteady on their feet, or seem unlike themselves for up to an hour. This is the brain recovering, not a sign of damage. Stay calm, keep your child warm and close, and continue to monitor their breathing.
Do not be alarmed if your child does not return immediately to their usual self. The confusion and sleepiness after a febrile seizure can last 30 minutes to an hour in some children. If your child remains very unresponsive, if breathing is laboured, or if you are worried, call 999.
Do febrile seizures cause brain damage?
This is the question every parent asks, and the answer from the evidence is reassuring. Simple febrile seizures do not cause brain damage. The NHS and the AAP are both clear on this point. Large follow-up studies, including the US National Collaborative Perinatal Project which tracked thousands of children over many years, found no differences in intelligence, memory, behaviour, or neurological development between children who had febrile seizures and those who did not. The brief period of oxygen disruption that can occur during a short febrile seizure is not long enough to cause harm to the developing brain.
Will my child have another one? Recurrence risk
Around 1 in 3 children (approximately 30%) who have a febrile seizure will go on to have at least one more. The risk of recurrence is higher if the first seizure happened before 18 months of age, if a parent or sibling has a history of febrile seizures, or if the fever was relatively low at the time of the seizure. Knowing about this risk in advance helps you feel prepared rather than panicked if it happens again. Children who have recurrent febrile seizures are usually reviewed by a paediatrician, but recurrent febrile seizures by themselves are not the same as epilepsy.
Febrile seizures and epilepsy
The risk of later developing epilepsy is slightly elevated in children who have had febrile seizures, but the absolute numbers are reassuring. In the general population, around 1% of people develop epilepsy. In children who have had simple febrile seizures, the risk is around 2 to 4%. The risk is higher (closer to 10%) in children who had a complex febrile seizure, a family history of epilepsy, or neurodevelopmental concerns, which is why those children are usually referred to a paediatrician or paediatric neurologist for follow-up. But for the large majority of children who have a simple febrile seizure, epilepsy is not the expected outcome, and most go on to have entirely normal neurological development.
Can I prevent febrile seizures with paracetamol?
This is a reasonable instinct but the evidence is clear: giving paracetamol or ibuprofen at the first sign of a fever does not prevent febrile seizures. Research has consistently shown that antipyretic medication given during febrile illness does not reduce the risk of a seizure. This is because febrile seizures are triggered by the speed of the temperature rise, which typically happens very early in an illness, before medication can act. Use paracetamol and ibuprofen to keep your child comfortable when they have a fever, not as a seizure prevention strategy.
After a febrile seizure: GP and hospital follow-up
After any febrile seizure, your child should be assessed by a doctor. If you called 999, the paramedics or A&E team will manage this. If your child had a short seizure at home that resolved within a few minutes and you called 111, you will usually be advised to be seen the same day by your GP or to attend an urgent care centre. The doctor will examine your child to identify the cause of the fever, confirm the diagnosis, and rule out other causes of seizure such as meningitis or a febrile seizure with a more complex character. They will also talk you through what to expect and what to do if it happens again.
Frequently asked questions
Are febrile seizures dangerous?
Most febrile seizures are not dangerous. They are frightening to witness but the vast majority last less than 5 minutes, stop on their own, and cause no lasting harm. The NHS and AAP both confirm that simple febrile seizures do not damage the brain.
What should I do during my baby's febrile seizure?
Stay calm and stay with your child. Do not restrain their movements. Do not put anything in their mouth. Clear the space around them. Place them gently on their side in the recovery position to keep the airway clear. Time the seizure from when it starts. Call 999 if this is the first time, if the seizure lasts more than 5 minutes, or if your child does not start to recover within 30 minutes.
How long do febrile seizures last?
Most febrile seizures last between 1 and 3 minutes. A seizure lasting longer than 5 minutes is called a prolonged febrile seizure and requires an emergency call to 999. Seizures lasting more than 30 minutes are rare but more serious.
Will my baby have another febrile seizure?
Around 1 in 3 children who have a febrile seizure will have another one at some point. The risk is higher if the first seizure happened before 18 months of age, if there is a family history of febrile seizures, or if the fever was relatively low when the seizure occurred. Knowing this risk in advance helps you feel prepared, not panicked, if it happens again.
Do febrile seizures cause brain damage?
No. Simple febrile seizures do not cause brain damage. Large studies including the US National Collaborative Perinatal Project have followed children who had febrile seizures and found no differences in intelligence, behaviour, or neurological development compared with children who did not.
Should I give paracetamol early to prevent febrile seizures?
No. Research has shown that giving paracetamol or ibuprofen at the first sign of a fever does not prevent febrile seizures. Seizures are triggered by the rapid rise in temperature rather than the height of the fever, and this rise often happens before any medication can take effect. Use paracetamol and ibuprofen to keep your child comfortable, not as seizure prevention.
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