Few things frighten parents more than watching their child shake, go stiff and stop responding during a fever. Many believe their child is dying. Febrile seizures (also called febrile convulsions) are common, affecting roughly 2–5% of children between about 6 months and 5 years in many populations, and are usually harmless. But nurses must also make sure that a serious illness, such as meningitis or cerebral malaria, isn’t the cause.
What is a febrile seizure?
A seizure occurring with fever (usually 38°C or above) in a child aged roughly 6 months to 5 years, without an infection of the brain or another cause, and without a history of afebrile seizures. Common triggers are viral infections, ear infections, and sometimes fevers after vaccination.
Simple vs complex
| Simple febrile seizure | Complex febrile seizure |
|---|---|
| Generalised (whole body) | Focal features (one side or part of body) |
| Lasts less than 15 minutes | Lasts 15 minutes or more |
| Does not recur within 24 hours / same illness | Recurs within 24 hours or the same illness |
| Full recovery within about an hour | Incomplete recovery, or weakness afterwards |
Complex seizures need more detailed medical assessment.
During the seizure: first aid
- Note the time it started.
- Keep the child safe: on a flat surface, move hard objects away, protect the head.
- Don’t restrain them and don’t put anything in their mouth.
- Once the shaking stops, place the child in the recovery position.
- Loosen tight clothing; remove excess layers.
- Stay with them, observe breathing and colour.
- If the seizure lasts more than 5 minutes, treat as a prolonged seizure: call for emergency help and give emergency anticonvulsant (e.g. buccal midazolam or rectal diazepam) as prescribed or per protocol. See our seizure and status epilepticus guide.
Harmful traditional practices to discourage
In some communities, parents may put spoons, fingers or substances in the child’s mouth, pour cold water over the child, give cow’s urine, kerosene or herbal mixtures, or hold the child over smoke. These can cause choking, burns, aspiration and poisoning. Nurses should gently but clearly explain why these are dangerous.
After the seizure: assess for serious causes
- A–E assessment, temperature, blood glucose.
- Look for the source of fever: ears, throat, chest, urine.
- Meningitis warning signs: neck stiffness, bulging fontanelle, non-blanching rash, persistent drowsiness, irritability. See our meningitis guide.
- In malaria-endemic areas, test for malaria: convulsions in a febrile child can be a sign of severe/cerebral malaria. See our severe malaria guide.
- Check IMCI danger signs: convulsions are a general danger sign requiring urgent referral in IMCI.
- Children who don’t return to normal within an hour, who are under about 12–18 months, have had recent antibiotics (which can mask meningitis), or with complex seizures need careful medical review.
Fever management: myths and facts
- Paracetamol or ibuprofen can make a child more comfortable, but they do not prevent febrile seizures. Parents should not feel guilty that they “didn’t give medicine in time”.
- Tepid sponging is not recommended; it can cause shivering and discomfort. Cold baths are dangerous.
- Dress the child in light clothing, offer fluids, and keep the room comfortable.
- Don’t give both paracetamol and ibuprofen at the same time routinely; consider alternating only if distress persists, following guidance.
- Never give aspirin to children under 16 (risk of Reye’s syndrome).
Talking to parents
- Acknowledge their fear: “That must have been terrifying to watch.”
- Explain that simple febrile seizures don’t cause brain damage, and most children don’t develop epilepsy (the risk is only slightly higher than for other children).
- About 1 in 3 children will have another febrile seizure in a future illness, more likely if the first was at a young age or there’s a family history.
- Teach first aid for any future seizure, and when to call an ambulance (seizure over 5 minutes, breathing difficulty, child not waking, or another seizure soon after).
- Reassure that routine vaccinations remain important.
Based on NICE CKS Febrile seizure, NICE NG143 (Fever in under 5s), American Academy of Pediatrics guidance and WHO IMCI. Educational content: follow local protocols.