Clinical Reference Systems: Pediatric Advisor 10.0
Convulsions with Fever
Febrile convulsions are seizures triggered by high fever.
They are the most common type of convulsion and are usually
harmless. The average body temperature at which they occur
is 104ƒF (40ƒC). The fever itself can be caused by an
infection in any part of the body. Each febrile seizure
usually lasts 1 to 10 minutes without any treatment.
Febrile seizures do not cause any brain damage; however, a
few children (3%) will later have seizures without fever.
Febrile convulsions occur in 4% of children. Most of these
children have just one febrile seizure in a lifetime. The
other 40% of children who have had febrile seizures have one
to three recurrences over the next few years.
Children who have febrile seizures are usually 6 months to
4 years old. A child's first febrile seizure usually occurs
by 2 years of age. Febrile seizures usually stop occurring
by the time a child is 5 or 6 years old.
- Reduce the fever.
Bringing your child's fever down as quickly as possible
will shorten the seizure. Remove your child's clothing
and apply cold washcloths to the face and neck. Sponge
the rest of the body with cool water. As the water
evaporates, your child's temperature will fall. When
the seizure is over and your child is awake, give the
usual dose of acetaminophen or ibuprofen for your
child's weight and age, and encourage your child to
drink cool fluids.
- Protect your child's airway.
If your child has anything visible in the mouth, clear
it with a finger to prevent choking. Place your child
on the side or abdomen (face down) to help drain
secretions. If the child vomits, help clear the mouth.
Use a suction bulb if available. If your child's
breathing becomes noisy, pull the jaw and chin forward.
- Common mistakes in first aid of convulsions.
During the seizure, don't try to restrain your child or
stop the seizure movements. Once started, the seizure
will run its course no matter what you do. Don't try to
resuscitate your child just because breathing stops
momentarily for 5 to 10 seconds. Instead, try to clear
the airway. Don't try to force anything into your
child's mouth. This is unnecessary and can cut the
mouth, injure a tooth, cause vomiting, or result in a
serious bite of your finger. Don't try to hold the
tongue. Children may rarely bite the tongue during a
convulsion, but they can't swallow the tongue.
Call a rescue squad (911) IMMEDIATELY if the febrile
convulsion continues more than 5 minutes.
- Driving your child to a medical facility.
If you are told to drive to a medical facility, keep the
fever down during the drive. Dress your child lightly
and continue putting a cold washcloth on the forehead.
(Warning: Prolonged seizures due to persistent fever
have been caused by bundling up sick infants during a
- Oral fever-reducing medicines
Febrile convulsions usually occur during the first day
of an illness. Try to control fever more closely than
is necessary for children who do not have febrile
seizures. Begin acetaminophen or ibuprofen at the first
sign of any fever (a temperature over 100ƒF, or 37.8ƒC)
and give it continuously for the first 48 hours of the
illness. If your child has a fever at bedtime, awaken
him once during the night to give the fever medicine.
Because fever is common after DTP immunizations, begin
acetaminophen or ibuprofen in the physician's office
when your child is immunized and continue it for at
least 24 hours.
- Fever-reducing suppositories
Have some acetaminophen suppositories on hand in case
your child ever has another febrile seizure (same dosage
as oral medicine). These suppositories may be kept in a
refrigerator at the pharmacy, so you may have to ask for
- Light covers or clothing
Avoid covering your child with more than one blanket.
Bundling during sleep can push the temperature up 1 or 2
- Lots of fluids
Keep your child well hydrated by offering plenty of
The only way to prevent future febrile convulsions
completely is for your child to take an anticonvulsant
medicine on a daily basis until the age of 3 or 4 years.
Because anticonvulsants have side effects and febrile
seizures are generally harmless, anticonvulsants are rarely
prescribed unless your child has other neurologic problems.
Your physician will discuss this decision with you.
CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:
- Your child has a febrile convulsion.
- The neck becomes stiff.
- Your child becomes confused or delirious.
- Your child becomes difficult to awaken.
- Your child starts to act very sick.