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Simple febrile seizures in a child. First-choice treatments

FEATURED REVIEW Febrile seizures occur in around 3% of children. What are the essential points for healthcare professionals to keep in mind? And what are the warning signs to look out for?
Full review (4 pages) available for download by subscribers.

A simple febrile seizure is defined as an episode of generalised seizures lasting less than 15 minutes and occurring only once in 24 hours in a child during a febrile episode, without intracranial infection, metabolic disorders or a history of non-febrile convulsions. During a simple febrile seizure in a child, the priority is to prevent injury and then to lower body temperature when the convulsive movements have stopped.

Key points

  • Prevent injuries.
     
  • Estimate seizure duration.
     
  • Reduce body temperature with paracetamol.
     
  • If the seizure lasts more than 5 minutes: administer diazepam rectally, or midazolam by the oral transmucosal route.
     
  • Reassure the carers.
     
A écarterWarning signs during
a febrile seizure

Complex seizures.
10% to 20% of febrile seizures in children are classified as "complex" and require specific treatment by an emergency medical service as well as hospitalisation in order to investigate the cause. A complex seizure presents at least one of the following features:
  • duration of more than 15 minutes;
  • recurrence within 24 hours; 
  • partial seizure, i.e. with convulsions affecting only part of the body, without loss of consciousness;
  • neurological disorder following the seizure.
Situations in which there is a risk of meningitis.
Following a febrile seizure in a child, hospital admission for possible lumbar puncture is justified in the following situations:
  • history or examination suggestive of meningitis (including a seizure before the age of 6 months or after the age of 6 years, bulging fontanelle, neck stiffness);
  • ongoing antibiotic treatment, potentially masking the signs of meningitis;
  • infant aged 6 to 12 months, with weak immunity against Haemophilus influenza type b or pneumococcus, especially in the absence of vaccination against these bacteria.
For more information: > Download the full review (subscribers only)

©Prescrire 1 February 2019

"Simple febrile seizures in a child. First-choice treatments" Prescrire Int 2019; 28 (201): 48-51.  (Pdf, subscribers only).

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Download the full review.
Pdf, subscribers only

See also:

Midazolam oral
transmucosal route.
An alternative to rectal
diazepam for some children
Prescrire Int 2013;
22 (140) 173-177.
Pdf, subscribers only