Management of Seizures in Children

Initial Assessment and Classification

The American Academy of Pediatrics recommends checking temperature immediately to determine whether the seizure is febrile or afebrile, as this changes the diagnostic and therapeutic approach in children aged 6-60 months without prior neurological abnormalities 1
The classification of seizure type is crucial, with simple febrile seizures lasting less than 15 minutes, being generalized, and having a single episode in 24 hours, whereas complex febrile seizures last more than 15 minutes, have focal features, or multiple episodes in 24 hours 2, 3, 4

For febrile seizures, the primary goal is to identify the source of fever, and lumbar puncture is not routinely indicated unless there are specific concerns for meningitis or encephalitis 1, 2, 5, 6
Laboratory testing should be guided by clinical presentation, and urine testing is recommended given the patient's age and fever, as urinary tract infection is a common serious bacterial infection in this age group 1, 2, 5, 6
EEG is recommended as part of the neurodiagnostic evaluation for a first unprovoked (afebrile) seizure 2, 5, 6

During an active seizure, maintaining airway and positioning the child on their side is crucial, and benzodiazepines are indicated if the seizure lasts more than 5 minutes or does not terminate spontaneously 1

The American Academy of Pediatrics recommends that neither continuous nor intermittent anticonvulsant therapy is recommended for children with simple febrile seizures, as the risks outweigh the benefits 3, 4, 1
Antipyretics, such as acetaminophen or ibuprofen, should be used for comfort, not seizure prevention, and do not prevent febrile seizure recurrence but promote comfort and prevent dehydration 3, 4, 1

The risk of developing epilepsy after simple febrile seizures is approximately 1% by age 7 years, and the recurrence risk is approximately 30% overall, but increases to 50% in children younger than 12 months at first seizure 3, 4, 1
No long-term adverse effects on IQ, academic performance, or neurocognitive function have been demonstrated from simple febrile seizures 3, 4