In short
A convulsion during a fever is one of the most frightening things a parent can witness, and one of the least dangerous. Here is exactly what to do in the moment, the five-minute rule, and why it is not epilepsy.
Emergency if: A seizure lasting more than five minutes, a first-ever seizure, difficulty breathing, twitching on one side only, more than one seizure in 24 hours, or sleepiness lasting over an hour — call emergency services now.
On your report
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On this page
01
What a febrile seizure is
A febrile seizure is a convulsion triggered by a fever in a young child, usually between six months and six years of age. The child may go stiff and twitch or jerk, lose consciousness, fail to respond when spoken to, and sometimes vomit or wet themselves. Afterwards they are often sleepy, irritable or confused for up to an hour.
It is set off by the fever rather than by the height of the temperature, and most happen in the first day of an illness — sometimes as the very first sign that a child is unwell, before anyone realises there is a fever at all. Ordinary childhood viral infections are the usual trigger.
02
What to do while it is happening
Note the time it starts. This matters more than anything else you will do, because the length of the seizure decides what happens next, and every parent overestimates it — a two-minute seizure feels like twenty. Protect the head with your hands or something soft, and move away anything nearby that could cause injury.
When the movements stop, put the child on their side in the recovery position and check that nothing in the mouth or throat is blocking their breathing. Stay with them. They will usually be drowsy and disoriented for a while, and that is expected rather than a bad sign.
03
What not to do
Do not move the child or try to hold them still. Restraining someone during a convulsion does not shorten it and risks injuring them. Do not put anything at all in their mouth — not a finger, not a spoon, not a cloth. The old belief about swallowing the tongue is wrong, and forcing objects into the mouth causes real injuries to teeth, gums and fingers.
Do not try to bring the temperature down by undressing the child or sponging them with cold water. It does not stop the seizure, and it can make a feverish child shiver and more distressed. Paracetamol and ibuprofen are fine for making an unwell child comfortable, but they do not reduce the chance of another febrile seizure, and giving them for that purpose is not worthwhile.
04
How long is too long
Most febrile seizures last two to three minutes, and lasting more than ten minutes is uncommon. The practical rule is five minutes: if the seizure is still going at five minutes, call emergency services. This is why noting the start time matters so much.
Doctors separate a straightforward febrile seizure from one that needs more thought. A seizure lasting longer than about fifteen minutes, one affecting only one part or one side of the body, or a second seizure within the same illness falls into the second group and prompts closer assessment.
05
It is not epilepsy, and a typical febrile seizure does not cause brain damage
This is the reassurance that matters, and it is worth stating plainly. A febrile seizure can seem frightening, but it is unlikely to harm your child or cause long-term effects. There is no evidence that simple febrile seizures cause brain damage or learning problems.
Febrile seizures are not the same thing as epilepsy. Children who have had one carry a slightly increased chance of developing epilepsy later, but that remains rare, and the number of febrile seizures a child has does not change it. Most children stop having them by school age.
06
After a first one
Call emergency services for a child's first-ever febrile seizure, even a brief one that has already stopped, because it needs to be checked in hospital even though the seizure itself is usually harmless. The purpose is not the convulsion but the illness behind it — in a young child the important job is to rule out meningitis and other serious infection, and that means an examination, sometimes blood or urine tests, and occasionally a lumbar puncture.
Febrile seizures cannot be prevented. If your child has had one, the useful preparation is knowing the plan: how to position them, how to time it, the five-minute threshold, and that the illness underneath is what to focus on once the seizure has passed.
When to act
Routine — see a doctor
A child known to have febrile seizures who has a brief one during an illness, recovers, and is behaving normally afterwards: treat the illness and review with your doctor as advised.
Same-day — call promptly
A child known to have had febrile seizures before who has another brief one and recovers still needs a medical assessment the same day for the infection behind it.
Emergency — act now
A seizure lasting more than five minutes, a first-ever seizure, difficulty breathing, twitching on one side only, more than one seizure in 24 hours, or sleepiness lasting over an hour — call emergency services now.
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Sources
- Febrile Seizures — NHSnhs.uk
- Seizures — MedlinePlusmedlineplus.gov
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