When to get help

Call emergency services — 999 in the UK, 112 or 999 in Ireland and the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if your child:

has a seizure for the first time;
has a seizure lasting more than 5 minutes;
is having difficulty breathing;
has stiffness and twitching on only one side of their body;
is more sleepy than usual for more than 1 hour after the seizure stops;
has more than one seizure within 24 hours.

That list is the NHS's. It also gives one instruction people get wrong under pressure: do not take your child to the emergency department if they are still fitting or unconscious — call an ambulance instead, and do not drive yourself. KidsHealth New Zealand uses the same five-minute rule for calling an ambulance.

A first febrile seizure sits in the red column of the NICE traffic light system in its most severe form, status epilepticus, and any first fit needs a doctor to work out what caused the fever.

What one looks like

The NHS describes it: your child may become stiff and twitch, shake or have jerking movements; become unconscious; not respond or look at you when you talk to them; be sick or wet themselves; and be sleepy, irritable or confused for up to an hour afterwards. Most last two to three minutes, and it is rare for one to last more than ten. They usually affect children between six months and six years old.

That age range is worth holding on to. A seizure in a baby younger than six months is outside the usual pattern for febrile convulsions and needs assessing on its own terms.

What to do while it is happening

Note the time it starts and the time it stops. This is the single most useful thing you can do, and it is the thing everyone forgets.
Protect their head with your hands or something soft.
Move dangerous objects out of the way.
Afterwards, put them in the recovery position and check there is nothing in their mouth or throat that could affect breathing.

And what not to do, also from the NHS: do not move your child or try to hold them still; do not put anything in their mouth; and do not try to lower their temperature by undressing them or sponging them with cold water.

What happens next

Most febrile seizures need no treatment, but the NHS says a child will need to be checked in hospital after a first one, and may need to stay for a short time. Tests can include blood tests, a urine test, and sometimes a lumbar puncture to check the fluid around the spine for bacteria or viruses. If an infection is causing the fever, that gets treated. Very rarely, for a child who keeps having seizures, a doctor may prescribe a medicine to give during a seizure, with instructions on how to use it.

Prevention: the part that surprises people

You cannot prevent them. The NHS says so directly. More usefully, NICE settles the question people actually ask, which is whether keeping the temperature down with medicine will stop a fit: "antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose".

That is not an argument against ever giving paracetamol or ibuprofen. NICE's position is that you may consider either in a child with fever who appears distressed, and stop when they are comfortable again — but not with the sole aim of lowering a number, and not as seizure prophylaxis. Doses depend on age, weight and country, so check the packaging or ask a pharmacist. Aspirin is not for children under 16.

Does it mean epilepsy?

Almost always not. The NHS states that febrile seizures are not the same thing as epilepsy, and that children who have had one have a slightly increased chance of developing epilepsy later in life, but that this is rare. It does not quantify the increase, and neither will we.

Nursery, childcare and telling people

There is no exclusion rule attached to febrile seizures themselves; the exclusion, if any, belongs to whatever infection caused the fever. What is worth doing is telling anyone who looks after your baby that it has happened, because the first thirty seconds of the next one are much less frightening for someone who has been warned. Give them the same short script you now have: note the time, protect the head, clear the space, do not restrain, do not put anything in the mouth, call an ambulance at five minutes or for a first event.

Raising Children Network makes the wider point that any seizure in a child who is severely unwell or deteriorating rapidly is an emergency department problem regardless of duration. A short fit in a baby who then feeds and settles is a different situation from a short fit in a baby who stays floppy and will not rouse.

The thing to focus on afterwards

Once the seizure has stopped, the question moves from the fit to the fever. NICE is explicit that a first fit is a reason to seek further advice, and its wider fever guidance still applies: a baby under three months with a temperature of 38°C (100.4°F) or higher is high risk, a baby aged three to six months at 39°C (102.2°F) or higher is at least intermediate risk, and a non-blanching rash, a bulging fontanelle or neck stiffness are red signs whether or not there has been a seizure.

Afterwards, many parents describe a period of watching the thermometer obsessively. It is understandable, and it is not useful. NICE tells clinicians not to use the height of the temperature alone above six months, and not to use the duration of fever to predict serious illness. Watching your baby — how they feed, how they breathe, how easily they rouse — tells you more than the display does.

Febrile Convulsions