Febrile convulsions are really common in children. For parents, they’re absolutely terrifying to watch. As clinicians, it’s so important that we give accurate advice and information to families, in order to help bust those febrile convulsion myths.
Febrile seizures (or convulsions) are seizure episodes that happen to young children in the context of a febrile illness. The child may have just a regular upper respiratory tract infection, and they have a febrile seizure during the illness.
In some cases, the child might not actually have a fever at the time they have the convulsion, but they may develop a fever a few hours later.
Myth 1. We need to keep the temperature down.
This is not the goal in children with febrile convulsions. We know that in the course of a febrile illness, they may have a febrile convulsion, but we’re not going to desperately try to keep the temperature down in order to prevent it.
There isn’t any evidence that keeping the temperature down will stop the child having a febrile convulsion. Some children are prone to febrile convulsions. If they’re going to have one, they’re going to have one.
We should treat them with antipyretics in the same way we normally do. If the temperature is making the child distressed, or the child seems to be in pain, then we give antipyretics to help settle that fever (and therefore resolve their symptoms). We’re not giving the antipyretics with a view to stopping a febrile convulsion. Because, if it’s going to happen, it is going to happen.
This is very important for our discharge advice. The child will likely have another fever after discharge, and they may or may not have another febrile convulsion. Unfortunately, there’s nothing that the parents can do to prevent that from happening.
Myth 2. Febrile convulsions mean the child is going to grow up to have epilepsy.
It’s not the case that children with febrile convulsions go on to develop epilepsy.
There is a slightly increased risk. This changes according to the type of febrile convulsion.
Children who have had a one-off simple febrile convulsion (i.e. a generalised tonic-clonic seizure that resolves itself within 15 minutes) have a slightly higher risk than the general population of developing epilepsy.
In children who have had a complex febrile convulsion (longer than 15 minutes, focal, not recovering within an hour or recurrent episodes within 24 hours), there is a moderately increased risk of epilepsy. They have around a 10-20% risk of developing epilepsy.
Our biggest concern is the child who has very prolonged seizures. If they have a seizure lasting over 30 minutes, then they do have a higher risk of developing epilepsy. This is somewhere around 30 to 40%.
Myth 3. Febrile convulsions need medication to stop them.
This might be the case, but it’s not necessary in all cases. We manage them the same way we manage afebrile seizures. If the seizure stops within a short period of time (usually five minutes) then you don’t need to give any medication, but if the seizure continues for longer than five minutes, it is appropriate to give some medication. Our first-line treatment for these is benzodiazepines.
The vast majority of febrile convulsions we see in children are simple febrile convulsions that self-resolve within a couple of minutes without any medication.
Myth 4. Febrile convulsions cause brain damage or long-term problems.
This isn’t the case, and there’s no evidence that simple febrile convulsions or even short febrile convulsions that need medication to stop them, cause any long-term brain damage.
It’s something that families really worry about when they see their child having a seizure because it’s such a scary experience. Many parents will say that they thought their child was dying.
We can reassure families by reinforcing that there is no evidence that simple febrile convulsions cause any long-term effects on brain function or development.
Myth 5. We have to admit every patient with a febrile convulsion.
We don’t need to admit every patient with a febrile convulsion. Many patients who have their first episode of a febrile convulsion when it’s a simple (meaning short, generalized self-limiting) febrile convulsion and the child looks very well, can be discharged.
You may or may not know the source of fever. Use the NICE fever guidelines, and if the child is well with no red or amber fags, then that child doesn’t necessarily need to be admitted to the hospital.
If you discharge them then you need to give them appropriate safety netting on how to manage future febrile convulsions.
Key advice includes:
- Febrile convulsions are not the same as epilepsy
- Short seizures are not harmful
- 1 in 3 will have another febrile convulsion
- Return if there is another convulsion in the same illness
- Continue with routine immunisations even if the convulsion happened after one
There are reasons to admit children with febrile convulsions. If the seizures are prolonged, recurrent, focal, or the child looks unwell or takes a long time to recover, then you should admit them.
Another reason to admit is a parental concern. If parents have had a child with a first febrile convulsion, they may be very worried and feel happier being observed overnight. If you have the resources to do that, it’s perfectly reasonable to admit for that reason, too.
Duthie and Begley, https://doi.org/10.1016/j.paed.2021.08.003 2021
Rice SA, Müller RM, Jeschke S, Herziger B, Bertsche T, Neininger MP, Bertsche A. Febrile seizures: perceptions and knowledge of parents of affected and unaffected children. Eur J Pediatr. 2021 Dec 7:1–9. doi: 10.1007/s00431-021-04335-1. Epub ahead of print. PMID: 34873647; PMCID: PMC8648401.