Febrile Seizure in a Child: What to Do and When to Call 911

As cold and flu season starts in Amman, plenty of children run a fever. For some, the fever brings a moment parents never forget: the child suddenly goes stiff, their eyes roll back, their body jerks and they don't respond. This is usually a febrile seizure, the most common kind of seizure in young children. It's terrifying to watch, but most are short and leave no lasting harm. This guide explains what to do in the first minutes, when to call 911, and what happens afterwards.

What is a febrile seizure and what does it look like?

A febrile seizure is a fit that happens with a high temperature in an otherwise healthy child, usually between 6 months and 5 years old and most often at 12 to 18 months, according to the American Academy of Pediatrics (the NHS gives a range up to 6 years). It often happens on the first day of an illness, sometimes before parents have noticed the fever. According to the NHS, your child may:

• Go stiff, then shake, twitch or jerk.
• Lose consciousness, or not respond or look at you when you talk to them.
• Be sick or wet themselves.
• Be sleepy, irritable or confused for up to an hour afterwards.

Most last 2–3 minutes, and it's rare for one to last more than 10. Doctors separate simple febrile seizures, which are the most common, from complex ones:

What should you do during a febrile seizure?

According to the NHS, the American Academy of Pediatrics and MedlinePlus, your job is to keep your child safe until it stops:

• Check the time the seizure starts and ends. If someone else is there, ask them to film it on a phone for the doctor.
• Lay them on a soft surface such as a carpeted floor or a bed, move hard or sharp objects away, and protect their head with your hand or something soft.
• Turn them onto their side so saliva or vomit can drain out, and loosen tight clothing around the neck.
• Put nothing in their mouth — not a finger, a spoon or medicine. They will not swallow their tongue.
• Don't hold them down or try to stop the movements.
• Don't put them in a bath or under cold water, and don't sponge them with cold water or strip them to cool them.
• Stay with them; once the jerking stops, put them in the recovery position and check nothing in their mouth is blocking their breathing.

When should you call 911 or go to the ER for a febrile seizure?

Call 911 for

• A seizure lasting more than 5 minutes.
• Difficulty breathing, or blue lips or face.
• A child who doesn't wake up or respond after the seizure stops.
• Another seizure after the first one.
• Your child's first ever seizure — the NHS advises calling an ambulance or going to the emergency department. Don't drive while your child is still seizing or unconscious.

Go to the ER now

• A first seizure that stopped quickly and your child is waking up — they still need to be checked the same day.
• Jerking or stiffness on only one side of the body.
• More sleepy than usual for more than an hour after the seizure.
• A baby under 6 months who has had a seizure with fever.
• Signs of meningitis: a stiff neck, a rash that doesn't fade when pressed, dislike of bright light, or a bulging soft spot in a baby. Read our guide to meningitis symptoms and the glass test.
• Your child hit their head when they fell during the seizure — see our guide to head injuries in children.

Urgent care or a doctor the same day

• A child who has had simple febrile seizures before, has a similar short one and is back to normal — so a doctor can find the cause of the fever.
• A fever lasting more than 5 days, earache, a sore throat, or pain when peeing.
• A child drinking less than usual or having fewer wet nappies.

Home care is usually fine

• After a doctor has checked your child and reassured you: a fever in a child who is drinking, playing and wakes easily.
• Fever medicine for comfort and plenty of fluids. For fever thresholds by age, see child fever: when to worry.

Can fever medicine prevent a febrile seizure?

No — and many parents blame themselves for this without reason. The NHS says febrile seizures can't be prevented, and NICE, MedlinePlus and the American Academy of Pediatrics confirm that paracetamol and ibuprofen don't lower the chance of one. They do make a feverish child more comfortable, so use them for comfort at the dose on the pack, and never give aspirin to anyone under 16. For when the fever itself needs a doctor, read our guide to fever and when to go to urgent care.

Will it happen again, and is it epilepsy?

According to the American Academy of Pediatrics, about 1 in 3 children have another one, rising to about 1 in 2 if the first happened before their first birthday. The NHS is clear that febrile seizures aren't epilepsy; the chance of epilepsy later is slightly higher but still rare. Most children outgrow them by school age with no effect on the brain or learning. If seizures keep happening, a doctor may prescribe a medicine to give during a seizure and show you how to use it.

What happens when you come in?

If the seizure is still going, the priority is stopping it and protecting your child's breathing. Once it has stopped, the doctor asks how long it lasted and what it looked like (a video helps a lot), then examines your child for the cause of the fever, such as an ear, throat or urine infection, and checks for signs of meningitis. Depending on your child's condition, the doctor may request tests such as blood or urine tests from the on-site laboratory. If your child needs observation or further tests, the team will arrange the next step. The emergency department is open 24/7 with emergency physicians on site, and it's worth saving the emergency numbers in Jordan in your phone.

Sources

• NHS — Febrile seizures
• American Academy of Pediatrics (HealthyChildren.org) — Febrile seizures
• MedlinePlus — Febrile seizures
• NICE — Fever in under 5s: assessment and initial management (NG143)
• NHS — Meningitis