Febrile convulsions (also known as febrile seizures) are convulsive episodes brought on by a rapid increase in body temperature and most commonly occur in children between 6 months and 5 years of age. Although these seizures can be alarming for parents and caregivers, they are typically brief and do not cause long-term harm. Here’s a step-by-step guide on how to provide first aid when a child experiences a febrile convulsion:
Signs & Symptoms for febrile convulsions
- Sudden loss of consciousness with stiffening and rhythmic jerking of the arms and legs
- Rolling back of the eyes and possible foaming at the mouth
- Breathing difficulty or brief pauses in breathing, sometimes with a bluish tinge to lips or face
- Post-ictal drowsiness or irritability lasting up to 15 minutes after the convulsion ends
When to Call Emergency Services
- Seizure lasts longer than 5 minutes
- Convulsions recur without the child regaining alertness in between episodes
- Child does not recover consciousness within 15 minutes after the seizure stops
- Seizure has focal features (e.g., only one arm or leg jerking) or child is under 18 months/over 6 years
- Any first-time seizure, difficulty breathing, or signs of injury during the fit
First Aid Steps for febrile convulsions
- Note the start time and stay calm knowing seizure duration guides treatment urgency.
- Place the child on a firm, flat surface and gently cushion their head; clear surrounding hazards to prevent injury.
- Do not restrain movements or insert objects into the mouth this risks airway blockage and trauma.
- Once convulsions stop, roll the child into the recovery position with the head tilted back to keep the airway open.
- Remove excess clothing and cool the environment; do not attempt sponging or bathing until after seizures end.
- After full recovery of consciousness, offer fluids and administer age-appropriate paracetamol or ibuprofen per dosing guidelines to reduce fever.
Do’s and Don’ts
| Do | Don’t |
|---|---|
| Keep calm, time the seizure, and protect the child’s head | Restrain or shake the child during convulsions |
| Remove hazards and place the child on a flat surface | Insert objects or your fingers into the mouth |
| After the seizure, position the child on their side | Attempt to cool or sponge until seizure ends |
| Monitor breathing and level of consciousness continually | Delay seeking help if seizure exceeds 5 minutes |
| Note the fit’s duration and characteristics for medical review | Ignore repeated or complex seizures—call EMS |
Classification of Febrile Convulsions
| Feature | Simple Febrile Seizure | Complex Febrile Seizure |
|---|---|---|
| Duration | < 15 minutes | > 15 minutes |
| Generalization | Generalized (both sides of body) | Focal onset (one limb or side) |
| Recurrence | Single episode in 24 hours | Recurrent within 24 hours |
| Neurological Findings | Normal neurologic exam and development afterward | Possible postictal weakness or focal signs |
Understanding whether a seizure is simple or complex guides decisions on further evaluation and follow-up care.
Risk Factors & Predictors
- Age 6–18 months at first seizure
- Family history of febrile seizures
- Rapid rise in temperature (not the absolute fever height)
- Lower temperature at onset (< 38.4 °C) increases seizure likelihood
Awareness of these factors helps identify children at higher risk and tailor educational efforts for families.
Immediate After-Seizure Management
- Follow DRSABCD (Danger, Response, Send for help, Airway, Breathing, CPR, Defibrillation).
- Place child in recovery position; keep airway clear.
- Remove excess clothing; allow heat dissipation—do not sponge or bathe until seizure ends.
- Monitor breathing and circulation until fully alert.
- Record seizure start and end times, characteristics (tonic, clonic, focal), and any triggers.
Documenting these details ensures accurate communication with healthcare providers.
Post-Seizure Assessment & Referrals
- Seek immediate medical care if any of the following apply:
- Complex features (focal signs, prolonged > 15 min, recurrence)
- Under 6 months of age or over 5 years at onset
- Failure to return to baseline consciousness within 15 min
- Signs of central nervous system infection (neck stiffness, rash, persistent fever)
- Consider lumbar puncture in infants 6–12 months when meningitis can’t be ruled out clinically.
Timely referral prevents missed diagnoses of serious underlying causes.
Prophylactic & Preventive Strategies
| Intervention | Recommendation |
|---|---|
| Routine antipyretics | Not effective to prevent seizures; use for comfort only |
| Intermittent diazepam | 0.3–0.5 mg/kg rectally or orally at fever onset for recurrence risk |
| Continuous anticonvulsants | Reserved for very frequent, prolonged, or atypical cases |
Most children do not require daily medication; intermittent prophylaxis is reserved for those with recurrent complex febrile seizures.
Parent & Caregiver Education
- Provide a Seizure Action Plan: steps to take, emergency contacts, dosing instructions for intermittent diazepam.
- Teach safe environment measures: clear floor space, remove hard or sharp objects.
- Reassure that simple febrile seizures rarely cause brain damage or epilepsy.
- Stress importance of fever management—maintain hydration, lightweight clothing, and appropriate antipyretics for comfort.
REFERENCES
- Fever – febrile convulsions, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fever-febrile-convulsions
- How to treat febrile convulsions, https://www.stjohnwa.com.au/online-resources/first-aid-information-and-resources/febrile-convulsions
- John Furst ,First Aid Guide to Febrile Convulsions, Updated December 30, 2018, https://www.firstaidforfree.com/first-aid-guide-to-febrile-convulsions/
- Lorraine Bunag, What To Do If A Child Has Febrile Seizures, Updated 06/03/2022, https://hellodoctor.com.ph/parenting/child-health/child-health-issues/convulsions-first-aid/
- Eilbert W, Chan C; Febrile seizures: A review. J Am Coll Emerg Physicians Open. 2022 Aug 23;3(4):e12769. doi: 10.1002/emp2.12769. eCollection 2022 Aug.
- Sawires R, Buttery J, Fahey M; A Review of Febrile Seizures: Recent Advances in Understanding of Febrile Seizure Pathophysiology and Commonly Implicated Viral Triggers. Front Pediatr. 2022 Jan 13;9:801321. doi: 10.3389/fped.2021.801321. eCollection 2021.
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