A febrile seizure is a seizure in a child, usually between 6 months and 5 years old, caused by fever without an infection of the brain. Most are short, simple and harmless, but serious causes such as meningitis must be ruled out.
Key symptoms
- Generalized shaking or stiffening with fever
- Rolling eyes, loss of awareness and not responding
- Short sleepiness or confusion after the seizure
- Signs of the infection: cough, runny nose, ear pain
What you find on exam
- Airway, breathing, circulation and glucose
- Temperature and source of fever: ears, throat, lungs, skin
- Signs of meningitis: stiff neck, bulging fontanelle, rash
- Return to normal level of alertness and a normal neurological exam
Tests
- Simple febrile seizure: usually no blood tests, imaging or EEG
- Look for the source of fever as you would without a seizure
- Lumbar puncture if signs of meningitis, or consider in infants with missing vaccines
- Glucose at the bedside
Treatment basics
- Protect from injury, place on the side, give nothing by mouth
- If it lasts over 5 minutes: benzodiazepine such as intranasal midazolam or IV lorazepam
- Treat the fever cause; acetaminophen or ibuprofen for comfort
- Reassure parents that simple febrile seizures do not harm the brain
- Teach seizure first aid; fever medicine does not prevent repeat seizures
Red flags
- Seizure lasting over 5 minutes or repeated seizures
- Child not back to normal within an hour
- Stiff neck, purple rash or bulging fontanelle
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Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NREMT psychomotor skill sheets (EMT and Paramedic). Written by Making Synapses. Making Synapses is not affiliated with these organizations.