Management of Febrile Seizures in Children

Diagnosis and Assessment

The American Academy of Pediatrics recommends reassuring the parents and identifying the source of fever, as this is a simple febrile seizure requiring no EEG, no head CT, and no antiepileptic drugs 1, 2
The primary objective is to identify the source of fever, particularly ruling out serious bacterial infections like meningitis and urinary tract infection, with a focus on assessing for meningeal signs and evaluating general appearance 2, 3
Assess for meningeal signs, such as altered mental status, neck stiffness, excessive drowsiness, or irritability, which mandate lumbar puncture regardless of age 2
Evaluate general appearance, as a child with toxic appearance, poor feeding, or incomplete recovery after one hour requires more aggressive evaluation 2, 3

Obtain urinalysis, as urinary tract infection is the most common serious bacterial infection in febrile children, with 5-7% prevalence 3
Assess for respiratory signs, and if tachypnea, retractions, or crackles are present, obtain chest radiography 2
Blood glucose should be checked if the child is seen during a seizure 4, 5

Administer paracetamol (acetaminophen) for comfort, not seizure prevention, as antipyretics improve comfort but do not prevent febrile seizure recurrence 1, 4, 7, 2
Avoid physical cooling methods, such as fanning, cold bathing, and tepid sponging, which cause discomfort and are not recommended 4, 6, 2
Ensure adequate hydration to prevent dehydration 4, 6

The prognosis is excellent, with a risk of subsequent epilepsy after a simple febrile seizure of only 2.5% 4, 5, 6
Recurrence risk is approximately 30% overall, but increases to 50% in children under 2 years of age 4, 2, 3
Provide home management instructions, including positioning the child on their side during a seizure, not placing anything in the mouth, and seeking emergency care if the seizure lasts more than 5 minutes 3
Warn parents about signs requiring immediate return, such as worsening general condition, skin rash/petechiae, respiratory distress, feeding refusal, excessive irritability, or somnolence 2

Reevaluate the child within 24 hours if managed as an outpatient 2
Document key elements, including accurate seizure description, family history of seizures, temperature on presentation, presence/absence of meningeal signs, and neurodevelopmental state when recovered 4, 5, 6