Understanding Febrile Seizures in Children

Understanding Febrile Seizures in Children

By Dr. Ankit Mehta, Pediatric Emergency & Critical Care Specialist, Zydus Hospital, Ahmedabad

One of the scariest experiences for any parent is watching their child suddenly stiffen, jerk, or roll their eyes during a fever. It feels like something out of a nightmare. But as a pediatrician specializing in emergency and critical care, I want to assure you: most febrile seizures are not dangerous and do not cause permanent harm. In this article, I will break down febrile seizures in simple terms—what they are, why they happen, how to respond, and when to seek help.

What is a Febrile Seizure?

A febrile seizure is a convulsion (or fit) that occurs in children between 6 months and 5 years of age, triggered by fever (typically above 100.4°F or 38°C). The child may lose consciousness, have jerking movements of the arms and legs, or become stiff. It usually lasts 1–5 minutes and is terrifying to watch, but rarely dangerous.

There are two types:

● Simple Febrile Seizure: Most common. Generalized shaking, lasts <15 minutes, doesn’t recur within 24 hours.

● Complex Febrile Seizure: May last >15 minutes, recur within 24 hours, or involve only one part of the body.

Why Do Febrile Seizures Happen?

It’s not how high the fever goes, but how quickly it rises that often triggers the seizure. It’s like the body’s thermostat rises too fast and causes a circuit overload in the brain.

What Happens During a Febrile Seizure?

● Sudden loss of consciousness

● Body becomes stiff or jerky

● Rolling of eyes

● Frothing at the mouth

● Involuntary urination or passing stools

Important: The child does NOT choke on their tongue. Do NOT try to put anything in their mouth.

What Should You Do During a Febrile Seizure?

1. Stay Calm

○ I know it’s easier said than done, but your child needs calm handling.

2. Lay the Child on Their Side

○ This helps prevent choking in case of vomiting.

3. Do Not Restrain the Movements

○ Let the seizure pass naturally. Holding the child tight can cause injury.

4. Do Not Put Anything in the Mouth

○ No fingers, spoons, or water. It may cause injury or choking.

5. Time the Seizure

○ Most end within 1–3 minutes. If it goes beyond 5 minutes, seek emergency care.

6. Post-Seizure Care

○ Your child may be drowsy or confused for 15–30 minutes. Let them rest. Keep them cool and hydrated.

When to See a Doctor Urgently

● Seizure lasts more than 5 minutes

● Occurs more than once in 24 hours

● Involves only one side of the body

● Child has trouble breathing, turns blue, or remains unresponsive

Can Febrile Seizures Be Prevented?

There is no guaranteed way to prevent them, but you can:

● Monitor and treat fevers early with paracetamol

● Avoid overdressing or bundling up a child with fever

● Ensure hydration with ORS or water

Example: One family I treated from Anand began tracking their son’s temperature every 4 hours during viral fevers. They noticed when his temperature would spike and started giving paracetamol just before the rise. Their son hasn’t had a seizure since.

Will My Child Have Epilepsy Later?

Most children outgrow febrile seizures by age 5. The chance of developing epilepsy later is very small (1-2% in most cases). Risk is slightly higher if:

● Family history of epilepsy

● Complex febrile seizures

● Developmental delays

Investigations and Scans

Simple febrile seizures usually don’t need any tests. But if it’s a complex seizure or a first-time event, your pediatrician may advise:

● Blood tests

● EEG (brain activity test)

● MRI brain (in rare cases)

Medications

Routine anti-epileptic drugs are not needed for simple febrile seizures. Sometimes, a rescue medicine like Midazolam nasal spray is prescribed to use at home if a seizure lasts over 3–5 minutes.

Support for Parents

I always reassure families: “This is not your fault.” Many parents feel guilt or fear. But febrile seizures are common in Indian children and usually harmless.

Talk to your doctor. Learn to recognize signs. Prepare a fever plan. That’s the best defense.

Final Thoughts

Febrile seizures can be frightening, but they are usually benign and manageable. Education and preparation can turn fear into confidence. I always say, “Be alert, not afraid.”

Let us, your pediatric team, walk this journey with you. With awareness, most children with febrile seizures grow up healthy, active, and seizure-free.

Dr. Ankit Mehta
Consultant Pediatrician & Pediatric Intensivist
Zydus Hospital, Ahmedabad
Member, Indian Academy of Pediatrics