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Febrile Seizures Treatment & Management

  • Author: Nooruddin R Tejani, MD; Chief Editor: Kirsten A Bechtel, MD  more...
Updated: Jun 06, 2016

Prehospital Care

See the list below:

  • Patients with active seizures should be treated with airway management, high-flow oxygen, supportive care, and anticonvulsants as necessary. Acute treatment such as rectal diazepam (0.5 mg/kg) and buccal 0.4-0.5 mg/kg) or intranasal (0.2 mg/kg) are effective and can be given at home for a seizure lasting longer than 5 minutes.[41, 42, 43]
  • Patients who are postictal should receive supportive care and antipyretics as appropriate.

Emergency Department Care

See the list below:

  • Patients presenting with status epilepticus should be treated with airway management and anticonvulsants as necessary.
  • Patients presenting with history and physical examination findings consistent with a simple febrile seizure should have frequent neurologic examinations to monitor mental status.
  • Other causes of seizure should be ruled out.
  • The cause of the febrile illness should be sought and treated.
  • Antipyretics should be considered. Acetaminophen (Tylenol) and ibuprofen (Motrin) are often used.
  • Parental anxiety and fear that their child may die or will develop brain damage needs to be addressed with reassurance and education.
Contributor Information and Disclosures

Nooruddin R Tejani, MD Assistant Professor, Department of Emergency Medicine, SUNY Health Sciences Center Brooklyn; Director, Pediatric Emergency Medicine, Downstate Medical Center

Nooruddin R Tejani, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Kirsten A Bechtel, MD Associate Professor of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine; Co-Director, Injury Free Coalition for Kids, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Additional Contributors

Debra Slapper, MD Physician, Southwest Washington Free Clinic System-Urgent Care; Former FEMA Physician and Military Contractor; Former Associate Professor, University of Miami, Leonard M Miller School of Medicine and University of South Florida Morsani College of Medicine

Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, William T Zempsky, MD, to the development and writing of this article.

  1. Consensus statement. Febrile seizures: long-term management of children with fever-associated seizures. Pediatrics. 1980 Dec. 66(6):1009-12. [Medline].

  2. [Guideline] Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. 1993 Jul-Aug. 34(4):592-6. [Medline].

  3. Matsuo M, Sasaki K, Ichimaru T, Nakazato S, Hamasaki Y. Increased IL-1beta production from dsRNA-stimulated leukocytes in febrile seizures. Pediatr Neurol. 2006 Aug. 35(2):102-6. [Medline].

  4. Gatti S, Vezzani A, Bartfai T. Mechanisms of fever and febrile seizures: putative role of the interleukin-1 system. Baram TZ, Shinnar S. Febrile Seizures. San Diego, Ca: Academic Press; 2002. 169-88.

  5. Haspolat S, Mihci E, Coskun M, Gumuslu S, Ozben T, Yegin O. Interleukin-1beta, tumor necrosis factor-alpha, and nitrite levels in febrile seizures. J Child Neurol. 2002 Oct. 17(10):749-51. [Medline].

  6. [Guideline] American Academy of Pediatrics. Provisional Committee on Quality Improvement, Subcommittee on Febrile Seizures. Practice parameter: the neurodiagnostic evaluation of the child with a first simple febrile seizure. Pediatrics. 1996 May. 97(5):769-72; discussion 773-5. [Medline].

  7. Millichap JG, Millichap JJ. Role of viral infections in the etiology of febrile seizures. Pediatr Neurol. 2006 Sep. 35(3):165-72. [Medline].

  8. Kwong KL, Lam SY, Que TL, Wong SN. Influenza A and febrile seizures in childhood. Pediatr Neurol. 2006 Dec. 35(6):395-9. [Medline].

  9. Audenaert D, Van Broeckhoven C, De Jonghe P. Genes and loci involved in febrile seizures and related epilepsy syndromes. Hum Mutat. 2006 May. 27(5):391-401. [Medline].

  10. Iwasaki N, Nakayama J, Hamano K, Matsui A, Arinami T. Molecular genetics of febrile seizures. Epilepsia. 2002. 43 Suppl 9:32-5. [Medline].

  11. Hirose S, Mohney RP, Okada M, Kaneko S, Mitsudome A. The genetics of febrile seizures and related epilepsy syndromes. Brain Dev. 2003 Aug. 25(5):304-12. [Medline].

  12. Nakayama J, Arinami T. Molecular genetics of febrile seizures. Epilepsy Res. 2006 Aug. 70 Suppl 1:S190-8. [Medline].

  13. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J (Clin Res Ed). 1985 May 4. 290(6478):1307-10. [Medline].

  14. Hauser WA. The prevalence and incidence of convulsive disorders in children. Epilepsia. 1994. 35 Suppl 2:S1-6. [Medline].

  15. Chung B, Wat LC, Wong V. Febrile seizures in southern Chinese children: incidence and recurrence. Pediatr Neurol. 2006 Feb. 34(2):121-6. [Medline].

  16. Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J. Death in children with febrile seizures: a population-based cohort study. Lancet. 2008 Aug 9. 372(9637):457-63. [Medline].

  17. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med. 1976 Nov 4. 295(19):1029-33. [Medline].

  18. Berg AT, Shinnar S. Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology. 1996 Aug. 47(2):562-8. [Medline].

  19. van Esch A, Steyerberg EW, van Duijn CM, Offringa M, Derksen-Lubsen G, van Steensel-Moll HA. Prediction of febrile seizures in siblings: a practical approach. Eur J Pediatr. 1998 Apr. 157(4):340-4. [Medline].

  20. Bethune P, Gordon K, Dooley J, Camfield C, Camfield P. Which child will have a febrile seizure?. Am J Dis Child. 1993 Jan. 147(1):35-9. [Medline].

  21. Vestergaard M, Basso O, Henriksen TB, Ostergaard JR, Olsen J. Risk factors for febrile convulsions. Epidemiology. 2002 May. 13(3):282-7. [Medline].

  22. Offringa M, Bossuyt PM, Lubsen J, Ellenberg JH, Nelson KB, Knudsen FU. Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies. J Pediatr. 1994 Apr. 124(4):574-84. [Medline].

  23. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child. 2004 Aug. 89(8):751-6. [Medline].

  24. Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med. 1997 Apr. 151(4):371-8. [Medline].

  25. [Guideline] Committee on Infectious Diseases. Policy statement—Prevention of varicella: update of recommendations for use of quadrivalent and monovalent varicella vaccines in children. Pediatrics. 2011 Sep. 128(3):630-2. [Medline].

  26. Sun Y, Christensen J, Hviid A, Li J, Vedsted P, Olsen J. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and Haemophilus influenzae type B. JAMA. 2012 Feb 22. 307(8):823-31. [Medline].

  27. Hand L. Delaying childhood vaccines ups postvaccine seizure risk. Medscape Medical News [serial online]. May 19, 2014;. Available at Accessed: May 28, 2014.

  28. Hambidge SJ, Newcomer SR, Narwaney KJ, Glanz JM, Daley MF, Xu S, et al. Timely versus delayed early childhood vaccination and seizures. Pediatrics. 2014 Jun. 133(6):e1492-9. [Medline].

  29. Duffy J, Weintraub E, Hambidge SJ, et al. Febrile Seizure Risk After Vaccination in Children 6 to 23 Months. Pediatrics. Published Online: June 2016. [Full Text].

  30. Garcia J. Risk for Febrile Seizure After Multiple Vaccines Is Low. Medscape Medical News. Available at June 06, 2016; Accessed: June 06, 2016.

  31. Sales JW, Bulloch B, Hostetler MA. Practice variability in the management of complex febrile seizures by pediatric emergency physicians and fellows. CJEM. 2011 May. 13(3):145-9. [Medline].

  32. Chamberlain JM, Gorman RL. Occult bacteremia in children with simple febrile seizures. Am J Dis Child. 1988 Oct. 142(10):1073-6. [Medline].

  33. Papageorgiou V, Vargiami E, Kontopoulos E, Kardaras P, Economou M, Athanassiou-Mataxa M, et al. Association between iron deficiency and febrile seizures. Eur J Paediatr Neurol. 2015 Jun 12. [Medline].

  34. Teng D, Dayan P, Tyler S, Hauser WA, Chan S, Leary L. Risk of intracranial pathologic conditions requiring emergency intervention after a first complex febrile seizure episode among children. Pediatrics. 2006 Feb. 117(2):304-8. [Medline].

  35. Kimia AA, Ben-Joseph E, Prabhu S, Rudloe T, Capraro A, Sarco D. Yield of emergent neuroimaging among children presenting with a first complex febrile seizure. Pediatr Emerg Care. 2012 Apr. 28(4):316-21. [Medline].

  36. Nordli DR Jr, Moshé SL, Shinnar S, Hesdorffer DC, Sogawa Y, Pellock JM, et al. Acute EEG findings in children with febrile status epilepticus: results of the FEBSTAT study. Neurology. 2012 Nov 27. 79(22):2180-6. [Medline]. [Full Text].

  37. Kimia AA, Capraro AJ, Hummel D, Johnston P, Harper MB. Utility of lumbar puncture for first simple febrile seizure among children 6 to 18 months of age. Pediatrics. 2009 Jan. 123(1):6-12. [Medline].

  38. Hom J, Medwid K. The low rate of bacterial meningitis in children, ages 6 to 18 months, with simple febrile seizures. Acad Emerg Med. 2011 Nov. 18(11):1114-20. [Medline].

  39. Fletcher EM, Sharieff G. Necessity of lumbar puncture in patients presenting with new onset complex febrile seizures. West J Emerg Med. 2013 May. 14(3):206-11. [Medline]. [Full Text].

  40. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011 Feb. 127(2):389-94. [Medline].

  41. McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005 Jul 16-22. 366(9481):205-10. [Medline].

  42. Bhattacharyya M, Kalra V, Gulati S. Intranasal midazolam vs rectal diazepam in acute childhood seizures. Pediatr Neurol. 2006 May. 34(5):355-9. [Medline].

  43. Sadleir LG, Scheffer IE. Febrile seizures. BMJ. 2007 Feb 10. 334(7588):307-11. [Medline].

  44. van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW, Habbema JD, Moll HA. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. Pediatrics. 1998 Nov. 102(5):E51. [Medline].

  45. [Guideline] Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures American Academy of Pediatrics. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008 Jun. 121(6):1281-6. [Medline].

  46. Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med. 2009 Sep. 163(9):799-804. [Medline].

  47. Autret E, Billard C, Bertrand P, Motte J, Pouplard F, Jonville AP. Double-blind, randomized trial of diazepam versus placebo for prevention of recurrence of febrile seizures. J Pediatr. 1990 Sep. 117(3):490-4. [Medline].

  48. Rosman NP, Colton T, Labazzo J, Gilbert PL, Gardella NB, Kaye EM. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med. 1993 Jul 8. 329(2):79-84. [Medline].

  49. Verity CM, Golding J. Risk of epilepsy after febrile convulsions: a national cohort study. BMJ. 1991 Nov 30. 303(6814):1373-6. [Medline].

  50. Berg AT. Febrile seizures and epilepsy: the contributions of epidemiology. Paediatr Perinat Epidemiol. 1992 Apr. 6(2):145-52. [Medline].

  51. Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. II--Medical history and intellectual ability at 5 years of age. Br Med J (Clin Res Ed). 1985 May 4. 290(6478):1311-5. [Medline].

  52. Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. N Engl J Med. 1998 Jun 11. 338(24):1723-8. [Medline].

  53. Tarkka R, Paakko E, Pyhtinen J, Uhari M, Rantala H. Febrile seizures and mesial temporal sclerosis: No association in a long-term follow-up study. Neurology. 2003 Jan 28. 60(2):215-8. [Medline].

  54. Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med. 1976 Nov 4. 295(19):1029-33. [Medline].

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