Clinical Knowledge Summaries: Previous version Febrile convulsion

Previous version: Febrile convulsion

About this topic
Have I got the right topic?
Age from 6 months to 6 years
This guidance covers the management of a child who presents having had a febrile convulsion.
This guidance does not cover the emergency management of a child who is still convulsing, or
the management of a child who has epilepsy or other seizure disorder.
There is a separate CKS topic on Epilepsy.
The target audience for this guidance is health care professionals working within the NHS in
England, and providing first contact or primary health care. Patient information from NHS Direct
is intended to be printed and given to the parents of children with this condition, and the Shared
decision making sections are designed to provide a focus for discussion during the consultation
about the treatment options.

Changes
Version 1.0.0, revision planned in 2008.
Last revised in April 2005
October 2006 minor update. Antipyretic prescriptions updated because new doses of
ibuprofen for children are recommend by the British National Formulary. Issued in October 2006.

Previous changes
October 2005 minor technical update. Issued in November 2005.
January 2005 reviewed. Validated in March 2005 and issued in April 2005.
September 2004 minor technical update. Issued September 2004.
July 2001 reviewed. Validated in November 2001 and issued in April 2002.
October 1998 written.

Update
New evidence
Evidence-based guidelines
No new evidence-based guidelines since 1 March 2007.
HTAs (Health Technology Assessments)
No new HTAs since 1 March 2007.
Economic appraisals
No new economic appraisals relevant to England since 1 March 2007.
Systematic reviews and meta-analyses
No new systematic review or meta-analysis since 1 March 2007.
Primary evidence
No new high quality randomized controlled trials since 1 March 2007.

New policies
No new national policies or guidelines since 1 March 2007.

New safety alerts

No new safety alerts since 1 March 2007.

Changes in product availability

No changes in product availability since 1 March 2007.

Concise knowledge for clinical scenarios

Which therapy?

Consider admission see Should I refer or investigate?

Reassure carers and inform them that:
o
Febrile convulsions do not harm the child. They do not cause brain damage. And, they
are not the same as epilepsy.

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Clinical Knowledge Summaries: Previous version Febrile convulsion

Epilepsy can develop later, but this is rare the chance is about 1 in 100 for children
who have had two or more febrile convulsions.
o
Febrile convulsions may recur the chance is about 1 in 3.

Treatment to prevent febrile convulsions is seldom needed, and would only be

started after assessment by a specialist.
Advise on controlling fever in the future.
o
Treating a fever will not prevent febrile convulsions from recurring, but it will ease
symptoms of fever.
o
High temperatures are best reduced by giving paracetamol or ibuprofen, and by
removing excess clothing and bedding.
o
Fanning and tepid sponging can distress the child, and are of no benefit.
Teach parents to manage a recurrent convulsion. They should:
o
Place the child in the recovery position on a soft surface, lying semi-prone with the face
turned to the side. This prevents the inhalation of vomit, keeps the airways open, and
prevents the child from hurting him- or herself.
o
Not force anything into the mouth.
o
Note the time that the convulsion started, and stay with the child.
o
Wait few minutes for the convulsions to stop and then phone the GP or NHS Direct.
o
Dial 999 and request ambulance transport to the nearest hospital accident and
emergency department if the convulsions continue for more than 5 minutes.
Advise on immunization
o
A febrile convulsion only rarely follows a immunization. The excess risks are:

For diphtheria, tetanus toxoid, and whole cell pertussis (DTP)

immunization: 69 children per 100,000 immunizations; risk increased on the
day of vaccination, but not subsequently.

For measles, mumps, and rubella (MMR): 2534 children per 100,000
vaccinations; risk increased 814 days after vaccination.
o
The vaccination schedule should be completed as there is no increased risk of febrile
convulsions with future vaccinations.
o
The risk of neurological and developmental problems is not increased when a febrile
convulsion is associated with a vaccination.

Practical prescribing points

For further information please see the Medicines Compendium (www.medicines.org.uk) or the
British National Formulary (www.bnf.org).

Should I refer or investigate?

Refer?

Most children who have had a febrile convulsion do not need to be admitted.
o
The main concern is the possibility of missing a more serious diagnosis such as
meningitis.
Strongly consider admission for observation, lumbar puncture or treatment if any of the
following factors are present:
o
Age under 18 months (may have meningitis without meningeal signs)
o
Signs of meningitis
o
Child was drowsy before the seizure, or is irritable, systemically unwell or 'toxic'
o
Petechial rash
o
Recent or current treatment with antibiotics (partially treated meningitis may not have
meningeal signs)
o
Complex convulsion (i.e. lasting longer than 10 minutes, or focal, or repeated in the
same episode of illness, or with incomplete recovery within 1 hour)
o
Early review by a doctor not possible
o
Inadequate home circumstances
o
Parents anxious or unable to cope
o
The cause of the fever requires hospital management in its own right
Consider referral if:
o
The diagnosis of febrile convulsion is in doubt.
o
Febrile convulsions have been severe, or complicated and prophylactic treatment might
be indicated.
o
The child might be at increased risk for epilepsy, for example, having a neurological or
developmental condition or because there is a history of epilepsy in parents or siblings.

Investigate?
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Clinical Knowledge Summaries: Previous version Febrile convulsion

Blood glucose. Rule out hypoglycaemia in a child who convulses for more than 5 minutes,
or who is excessively drowsy after the convulsion.
Urine microscopy and culture. If no cause for the fever is found, and the child is not to
be admitted, take a urine specimen (mid-stream urine, clean catch, suprapubic aspirate, or
catheter specimen) for microscopy and culture.
Other investigations should be guided by the cause of the fever rather than by the febrile
convulsion.

Follow-up advice

Prescriptions
Paracetamol s/f susp: 60mg to 120mg up to four times a day
Age from 6 to 11 months

Paracetamol 120mg/5ml oral suspension paediatric sugar free. Take 2.5ml to 5ml every 4 to
6 hours when required for relief of high temperature. Maximum of 4 doses in 24 hours.
Supply 150 ml.
NHS Cost 0.48
OTC Cost 3.49
Licensed use: yes

Paracetamol s/f susp: 120mg to 240mg up to four times a day

Age from 1 year to 6 years

Paracetamol 120mg/5ml oral suspension paediatric sugar free. Take one to two 5ml
spoonfuls every 4 to 6 hours when required for relief of high temperature. Maximum of 4
doses in 24 hours. Supply 300 ml.
NHS Cost 1.30
OTC Cost 6.98
Licensed use: yes

Ibuprofen s/f susp: 50mg three to four times a day

Age from 6 months to 1 year

Ibuprofen 100mg/5ml oral suspension sugar free. Take 2.5ml three to four times a day
when required for relief of high temperature. Do not exceed the stated dose. Supply 100 ml.
NHS Cost 2.69
OTC Cost 3.49
Licensed use: yes

Ibuprofen s/f susp: 100mg three times a day

Age from 1 year 1 month to 3 years 11 months

Ibuprofen 100mg/5ml oral suspension sugar free. Take one 5ml spoonful three times a day
when required for relief of high temperature. Do not exceed the stated dose. Supply 100 ml.
NHS Cost 2.69
OTC Cost 3.49
Licensed use: yes

Ibuprofen s/f susp: 150mg three times a day

Age from 4 to 6 years

Ibuprofen 100mg/5ml oral suspension sugar free. Take 7.5ml three times a day when
required for relief of high temperature. Do not exceed the stated dose. Supply 150 ml.
NHS Cost 2.71
OTC Cost 5.23
Licensed use: yes

Drug rationale
Drugs not included

Intravenous diazepam for seizure termination is not practical for use in primary care.
Midazolam for seizure termination is not included as it is not licensed for use in febrile
convulsions in the UK.
Diazepam in the rectal or oral form for prevention of recurrent febrile convulsions:
this treatment should only be initiated by a specialist. Diazepam in the oral form is not
licensed for use in febrile convulsions.

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Other benzodiazepines are not included, as they are not licensed for use in febrile
convulsions.
Oral anticonvulsants for prevention of recurrent febrile convulsions: this treatment
should only be initiated by a specialist.

Drugs included

Paracetamol is an effective and safe antipyretic and analgesic for children.

Ibuprofen is an effective and safe antipyretic and analgesic for children over the age of
12 months.

Shared decision making

Febrile convulsions occur in about 3 in 100 children under the age of 6 years. They
usually last less than 5 minutes.
o
They are not epilepsy.
o
They do not cause brain damage.
Any illness that causes a fever ('temperature') may cause a febrile convulsion. The
common causes are viral infections causing coughs, colds, 'flu, and so on.
Try to keep a fever down when your child has a feverish illness.
o
Paracetamol or ibuprofen reduce fever. Always have some in the home.
o
Remove the child's clothes.
Only one convulsion occurs in most cases. In about 3 in 10 cases another occurs with a
future feverish illness.
Learn how to put a child in the 'recovery position' lay him or her on their side with
their head to one side. Do not put anything into the mouth but remove anything that could
interfere with breathing (such as vomit or food).
Call a doctor or ambulance if the child does not recover quickly or if you feel that the
illness causing the fever is more serious than a common viral infection.
A febrile convulsion very occasionally follows a vaccination.

Detailed knowledge about this topic

Goals and outcome measures
Goals

To make an accurate diagnosis of febrile convulsion

To identify children who should be admitted to hospital for further assessment
To reassure and inform parents about the benign nature of febrile convulsions
To inform parents about the immediate home treatment of possible future febrile
convulsions

Outcome measures
The following outcome measure (selected from a set of outcome measurements for accident and
emergency services) would be suitable for clinical audit in primary care [Armon et al, 2003].

Proportion of children admitted with febrile seizure and no risk factors for meningitis.
o
Target: only admit those children who conform to the admission criteria and those
where the parents or carers cannot be reassured.

Background information
What is it?
What is a febrile convulsion (or febrile seizure)?

A febrile convulsion is a seizure occurring in a child aged 6 months to 5 years, associated

with fever arising from infection or inflammation outside the central nervous system in a
child who is otherwise neurologically normal [Offringa and Moyer, 2001].
A Delphi consensus development process failed to reach agreement on what threshold
temperature could be regarded as defining a fever. The final consensus was that fever
should be assumed to be present if the 'history and examination were indicative' [Armon et
al, 2003].
o
The age limits are arbitrary and should be used as guidelines in clinical practice.
Simple febrile convulsions are isolated, generalized, tonicclonic seizures lasting less
than 1015 minutes.
Complex febrile convulsions last about 1530 minutes, or are focal, or recur during the
febrile illness, or are not followed by full consciousness within an hour.

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What causes febrile convulsions?

The mechanisms causing febrile convulsions are not known. It may not be the fever that
causes the seizure, but release of cytokines, as a consequence of infection, that (a) cause
fever and (b) cause seizures. The risk of febrile convulsions depends upon the age of the
child, so reflecting maturational sensitivity to the cytokines with respect to seizure induction.
Consequently, much of the debate over the presence, height, or rate of rise of the fever
may be irrelevant [Stern, Personal Communication, 2005].

What conditions cause the fever in a child with febrile convulsions?

Viral infections and otitis media are the most common sources of fever in children with febrile
convulsions.

A comprehensive review of the literature identified the conditions usually associated with
febrile convulsions [Armon et al, 2003]. In decreasing order of frequency they are:
o
Viral infections
o
Otitis media
o
Tonsillitis
o
Urinary tract infection
o
Gastroenteritis
o
Lower respiratory tract infection
o
Meningitis
o
Post-immunization
Table 1 presents evidence of a low prevalence of serious bacterial illness in children with
febrile convulsions.
Table 1. Prevalence of serious bacterial illness in 455 children admitted to hospital with a
diagnosis of a first-time febrile convulsion [Trainor et al, 2001].

Test

Number performed

Number positive

Chest X-rays

208

26 pneumonia

Urine cultures

171

10

Blood culture

315

4 (all Streptococcus pneumoniae)

Stool cultures

14

2 (both Shigella sonnei)

Cerebrospinal fluid cultures

135

Bacterial meningitis
A main concern when assessing children who have had a febrile convulsion is to detect and
manage bacterial meningitis.

Bacterial meningitis can be effectively treated, and the consequences of delayed treatment
can be devastating.
The risk of bacterial meningitis is low in children with febrile convulsions [Trainor et al,
2001; Armon et al, 2003]. However, it is difficult to estimate the prevalence of bacterial
meningitis accurately because:
o
Many studies are hospital-based, but some children with febrile convulsions are
managed in primary care.
o
In many children a firm diagnosis of bacterial meningitis is frequently not possible,
either because a lumbar puncture to obtain cerebrospinal fluid (CSF) was not done, or
because the CSF culture and microscopy result was not definitive.

How common is it?

Between 2% and 4% of children have a febrile seizure [Smith, 1994; Armon et al, 2001;
Waruiru and Appleton, 2004].
The peak incidence is at 18 months [Waruiru and Appleton, 2004].
About 4% of febrile convulsions occur in the first 6 months of life, 90% between 6 months
and 3 years, and 6% after 3 years of age [Smith, 1994]. (The cited study had age criteria
that differed from those used in this guidance.)
About 5% of all paediatric medical attendances to an accident and emergency department in
Nottingham were for febrile convulsions [Armon et al, 2001]. About 70% of these children
were admitted.

How do I know my patient has it?

History

Age: 6 months to 5 years old (approximately)

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Convulsion:
o
Duration usually no longer than 36 minutes; class as complex if prolonged more
than 1015 minutes
o
Pattern usually generalized tonicclonic; class as complex if focal
o
Recovery of level of consciousness usually complete within an hour; class as
complex if not fully recovered within an hour
Temperature fever around the time of the convulsion
Previous febrile convulsion class as complex if convulsions recur in the same febrile
illness
Recent immunization it is rare for a febrile convulsion to be precipitated by a
immunization; see Does immunization increase the risk of febrile convulsions and other
complications? in Complications and prognosis.

Examination

Level of consciousness.
Focus of infection. An infection is usually found to be the source of the fever. Check for
viral infections, otitis media, tonsillitis, urinary tract infection (UTI), gastroenteritis, lower
respiratory tract infection, and meningitis.

Investigations

Investigations should be directed towards identifying the source of the fever.

o
UTI. When no focus of infection is found, and admission is not planned, take a urine
sample (mid-stream urine, clean catch, suprapubic aspirate, or catheter specimen) for
microscopy and culture.
o
Bacterial meningitis. A main concern is to identify children with bacterial meningitis.
Criteria for referral for investigation are fully detailed in the section When should I
admit or refer a child who has had a febrile convulsion? in Management issues.
Blood tests, electroencephalograms (EEGs), and neuroimaging are not required in the
evaluation of simple febrile convulsions.

[American Academy of Pediatrics, 1996; Armon et al, 2003]

What else might it be?

Epilepsy
Any other cause of convulsion with fever, or without fever, for example:
o
Meningitis (including partially treated bacterial meningitis)
o
Encephalitis
o
Cerebral palsy with intercurrent infection
o
Hypoglycaemia or other metabolic disorder
o
Neurodegenerative disorders
o
Poisoning
o
Non-accidental shaking injury, rarely

Note that complex febrile convulsions are more likely than simple febrile convulsions to be
provoked by a serious condition. Therefore, suspect serious pathology in a child who has had a
prolonged or focal febrile convulsion, or who has not recovered within an hour of a febrile
convulsion.
[Royal College of Physicians and the British Paediatric Association, 1991; Fukuyama et al, 1996]

Complications and prognosis

Complications

Long-term adverse effects are rare.

o
There is no evidence of subsequent impaired intelligence or poorer academic
achievement [Verity et al, 1998].
o
There is a slightly increased risk of epilepsy see under Prognosis below.

Prognosis
What is the risk of recurrence after a febrile convulsion?

Febrile convulsions recur in subsequent febrile illnesses in about 30% of children. Only
9% have more than three seizures [Smith, 1994; Fukuyama et al, 1996].
Recurrence is most common within a year of the first febrile convulsion (70%)
[Fukuyama et al, 1996].
Recurrence is more likely if:
o
The first febrile convulsion occurs under the age of 15 months.

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o
The first convulsion is complex.
o
There is a family history of febrile convulsions or epilepsy in a first-degree relative.
o
The child attends day nursery (due to increased frequency of febrile illnesses).
The recurrence rate is 10% in the absence of these risk factors; 25% with one risk factor;
50% with two risk factors; and approaches 100% with three or more risk factors.

[Knudsen, 1996; Armon et al, 2003]

What is the risk of epilepsy developing after a febrile convulsion?

The risk of subsequent epilepsy is rare but increases with each of the following factors:
o
Neurological abnormalities or developmental delay before the onset of febrile
convulsions
o
Atypical seizures
o
Family history of epilepsy
o
Complex convulsions
In the absence of these risk factors only 1% of children go on to develop epilepsy
(compared with 0.4% of children without a history of febrile convulsion) [Stenklyft and
Carmona, 1994; Knudsen, 1996; Berg et al, 1999].
A Danish study found that children who had febrile convulsions after measles, mumps, and
rubella (MMR) immunization were not at increased risk of later epilepsy (0.23% compared
with 0.60%; not statistically significantly different) [Vestergaard et al, 2004].

Does immunization increase the risk of febrile convulsions and other complications?

Immunization is rarely followed by a febrile convulsion.

o
A large cohort study estimated the risks of a febrile convulsion following immunization
with diphtheria, tetanus toxoid, and whole cell pertussis (DTP) and MMR [Barlow et al,
2001]. Excess rates of febrile convulsions were:

For DTP: 69 children per 100,000 immunizations; risk increased on the day of
immunization, but not subsequently. However, acellular DTPa is now used. We
found no study measuring the rate of febrile convulsions after immunization with
acellular pertussis, but since other reactions are generally fewer than with whole
cell preparations, it is likely to be no higher.

For MMR: 2534 children per 100,000 immunizations; risk increased 814 days
after immunization.
o
A recent study from Denmark of the relationship between MMR and febrile convulsions,
based on a larger number of immunized children than Barlow's gives similar relative
risks. The authors also found that children who had febrile convulsions after MMR
immunization were at slightly increased risk of further febrile convulsions [Vestergaard
et al, 2004].
Immunization-associated febrile convulsions are not likely to cause recurrent
febrile convulsions with future immunizations.
o
Children who had a febrile seizure following immunization were no more likely to have
a subsequent seizure than children who had a febrile seizure not associated with
immunization [Barlow et al, 2001].
Immunization-associated febrile convulsions are not likely to cause
neurobehavioural disorders.
o
The relative risk of developing one or more learning or developmental disabilities after
a febrile convulsion associated with immunization was 0.56 (95% confidence interval
0.07 to 4.2) [Barlow et al, 2001].

Management issues
Overview of management

Reassure carers that febrile convulsions do not harm the child.

Advise on controlling fever in the future: an antipyretic, cool clothing, no physical cooling.
Teach parents to manage a recurrent convulsion: recovery position, nothing forced into
mouth.
Recommend that immunization schedules be completed.
Admit children who need observation, investigation, or treatment of the underlying
condition: the main concern is to detect children at increased risk of meningitis.
Consider referral for children who are at increased risk for epilepsy.

When should I admit or refer a child who has had a febrile convulsion?
Criteria for admission
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Most children with a first febrile convulsion do not need to be admitted. The main
concern is the possibility of missing a more serious diagnosis such as meningitis.
Strongly consider admission for observation, lumbar puncture or treatment if any of the
following factors are present:
o
Age under 18 months (may have meningitis without meningeal signs)
o
Signs of meningitis (neck stiffness; photophobia; Kernig's sign; Brudzinski's signs;
bulging fontanelle; depressed level of consciousness, for example, Glasgow Coma scale
< 15 at 1 hour after the convulsion):

Kernig's sign: pain restricts leg straightening when supine and holding the thigh
flexed to a right angle

Brudzinski sign 1 (contralateral reflex, contralateral sign): when lying supine,

passive flexion of one leg results in a similar movement in the opposite leg

Brudzinski sign 2 (neck sign): knees and hips flex involuntarily when the neck is
flexed while supine

Test for meningism gently and considerately, as this can be painful

o
Child was drowsy before the seizure, or is irritable, systemically unwell or
'toxic'
o
Petechial rash
o
Recent or current treatment with antibiotics (because partially treated meningitis
may not have meningeal signs)
o
Complex convulsion (i.e. lasting longer than 10 minutes; or with focal features, e.g.
jerking affecting only one limb; or repeated in the same episode of illness; or with
incomplete recovery within 1 hour)
o
Early review by a doctor not possible
o
Inadequate home circumstances
o
Carer anxious or unable to cope
o
The cause of the fever requires hospital management in its own right

[Royal College of Physicians and the British Paediatric Association, 1991; American Academy of
Pediatrics, 1999; Armon et al, 2003; Warden et al, 2003; Waruiru and Appleton, 2004]

When should I refer a child who has had a febrile convulsion?

Consider referral if:

The diagnosis of febrile convulsion is in doubt.

The cause of the fever is in doubt.
Febrile convulsions have been severe, or complicated and prophylactic treatment might be
indicated.
The child might be at increased risk for epilepsy, for example, having a neurological or
developmental condition or because there is a history of epilepsy in parents or siblings
[Fukuyama et al, 1996].
The parents require additional reassurance that the child is not at risk of dying or of serious
complications.

How do I manage the fever?

Diagnose the cause of the fever

Seek the source of the fever.

o
Consider the following differential diagnosis: viral infection, otitis media, tonsillitis,
urinary tract infection (UTI), gastroenteritis, lower respiratory tract infection,
meningitis, post-immunization, post-ictal fever [Baumer and Paediatric Accident and
Emergency Research Group, 2004].
When no focus of infection is found, and admission is not planned, a urine sample should be
taken for dipstick test, microscopy, and culture [Armon et al, 2003].
o
Ideally the urine specimen should be from a suprapubic aspirate or catheter sample,
which may need to be obtained in hospital. If this is impractical, urine may be collected
by bag, mid-stream urine, clean catch, or pad; bear in mind that contamination of the
urine may make interpretation of culture results unreliable [Verrier-Jones, Personal
Communication, 2005]. The likelihood of urinary tract infection is very high if a dipstick
test of the urine is positive for both nitrite and leucocyte esterase [NHS CRD, 2004].

Treat the fever to ease symptoms

Prescribe paracetamol or ibuprofen.

Remove excessive clothing and bedding.
Avoid physical methods such as fanning, cold bathing, and tepid sponging their use is
controversial as they are felt to cause some discomfort and minimal benefit.

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[Royal College of Physicians and the British Paediatric Association, 1991; Fukuyama et al, 1996;
Meremikwu and Oyo-Ita, 2003; Watts et al, 2003]

What measures should I consider to prevent febrile convulsions?

Treatment to prevent recurrence of febrile convulsions is rarely necessary and

should only be prescribed after specialist assessment.
Treating fevers with antipyretics does not prevent febrile convulsions [Offringa and
Moyer, 2001].
Intermittent rectal diazepam given at the onset of a fever to prevent febrile convulsions
may be a suitable option, depending on home circumstances, for a child at high risk of
recurrence of severe or complicated seizures.
o
Diazepam (oral and rectal) at relatively high doses may prevent febrile convulsions in
subsequent illness if given at the onset of a febrile episode [Offringa and Moyer, 2001;
Masuko et al, 2003].
o
Rectal diazepam is safe for home use, providing parents are properly educated in its
use [Royal College of Physicians and the British Paediatric Association, 1991; Knudsen,
1996].
o
Adverse effects have been reported with intermittent use of diazepam; these included
ataxia (31.1%), lethargy (28.8%), and irritability (24.4%), but lasted no more than
36 hours [Verrotti et al, 2004].
o
Treatment to prevent febrile seizures should only be prescribed after specialist
assessment.
Continuous prophylaxis is controversial. Anticonvulsants such as phenobarbital are
minimally effective in preventing febrile convulsions on average 8 children would need to
be treated for 2 years to prevent 1 febrile convulsion and the benefits of prophylaxis are
outweighed by the risk of adverse effects [Offringa and Moyer, 2001].
No treatment is available to reduce the rare risk of subsequent epilepsy.
Immunization is not contraindicated after a febrile convulsion.
o
There is evidence to suggest that immunizations do not increase the risk of recurrent
febrile convulsions [Offringa and Moyer, 2001].

How should I counsel parents?

Inform parents that:

o
Although febrile convulsions are frightening to watch, they are not harmful to the child,
do not cause brain damage, and will not cause the child to die.
o
The child will be sleepy for up to an hour after the convulsion.
o
Febrile convulsions are not the same as epilepsy.
o
Epilepsy can develop later, but this is rare the chance is about 1 in 100 for children
who have had two or more febrile convulsions.
o
Febrile convulsions may recur about 1 in 3 children will have another febrile
convulsion.
o
Treatment to prevent febrile convulsions recurring is seldom necessary, nor is it worth
having to put up with the side effects or taking the risk of serious adverse effects.
o
If the child is at high risk for further seizures (e.g. having a neurological condition or
because there is a family history of epilepsy in parents or siblings), referral to a
specialist might be useful.
Advise parents on controlling high temperatures
o
The aim of controlling fever is to ease symptoms, not to prevent febrile convulsions.
o
High temperature is best reduced by giving paracetamol or ibuprofen, and by removing
excessive clothing and bedding.
o
Fanning and tepid sponging are likely to cause discomfort and are of little benefit.
Teach parents to manage a recurrent convulsion. They should:
o
Place the child in the recovery position on a soft surface, lying semi-prone with the face
turned to the side. This prevents the inhalation of vomit, keeps the airways open, and
prevents the child from hurting him- or herself.
o
Not force anything into the mouth.
o
Note the time that the convulsion started, and stay with the child.
o
Wait a few minutes for the convulsions to stop, then phone their GP or NHS Direct.
o
Dial 999 if the convulsions continue more than 5 minutes, and request ambulance
transport to the nearest hospital accident and emergency department.
Counsel parents about immunization
o
Immunization is still advised after a febrile convulsion, even if, as rarely happens, the
febrile convulsion followed a immunization.

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Clinical Knowledge Summaries: Previous version Febrile convulsion

[Baumer et al, 1981; Gordon et al, 2001; Huang, 2001; Parmar et al, 2001; Huang et al, 2002;
Armon et al, 2003; Warden et al, 2003; Waruiru and Appleton, 2004]

References
NHS staff in England can link, free of charge, from references to the full text journal
articles by clicking on [NHS Athens Full-text]. You will need an NHS Athens password to
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All references with links to [Free Full-text] are freely available online to users in
England and Wales. This includes the full text of Department of Health papers and Cochrane
Library reviews.
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