Febrile convulsions are a type of seizure that occurs in children with a high fever. They are not caused by epilepsy or underlying brain pathology. Febrile convulsions occur only in children between the ages of 6 months and 5 years.
Young children have a lower seizure threshold. A high temperature (e.g., above 38°C) can stimulate excess neuronal firing, leading to a seizure.
Simple Febrile Convulsions
Simple febrile convulsions are generalised, tonic-clonic seizures. They last less than 15 minutes and only occur once during a single febrile illness.
Complex Febrile Convulsions
Complex febrile convulsions involve any of the following:
- Partial or focal seizures
- Lasts more than 15 minutes
- Occur multiple times during the same febrile illness
Presentation
A typical presentation is a child:
- Aged around 18 months
- A 2 – 5 minute tonic-clonic seizure
- Occurs during a high fever
The fever is usually caused by an underlying viral illness (e.g., roseola) or bacterial infection (e.g., tonsillitis).
Diagnosis
Diagnosis is based on the clinical presentation and requires excluding other pathologies. The differential diagnoses of a febrile convulsion are:
- Epilepsy
- Meningitis, encephalitis or another neurological infection, such as cerebral malaria
- Intracranial space-occupying lesions (e.g., brain tumours or intracranial haemorrhage)
- Syncopal episode
- Electrolyte abnormalities (e.g., severe hyponatraemia)
- Trauma, including non-accidental injury
Management
Key management steps include:
- Exclude other pathology
- Make a diagnosis
- Identify and treat the underlying cause of the fever
- Explain and educate the parents
The first febrile convulsion should always result in a hospital assessment by a paediatric specialist.
Complex febrile convulsions or any concerns on assessment (e.g., neurological deficit or diagnostic uncertainty) require further assessment.
Advice to parents on managing future episodes of febrile convulsions includes:
- Stay with the child
- Avoid moving them unless necessary (e.g., in a dangerous position)
- Remove nearby objects that could cause injury
- Protect their head from injury (e.g., with hands or a pillow to cushion their head)
- Place them in the recovery position
- Avoid putting anything in their mouth until they are fully recovered
- Call an ambulance if the seizure lasts more than 5 minutes
Prognosis
Febrile convulsions do not typically cause any lasting damage. One in three will have another febrile convulsion. The risk of developing epilepsy is:
- 1-2% for the general population
- 2-5% after a simple febrile convulsion
- 4-10% after a complex febrile convulsion
Last updated January 2026
Now, head over to members.zerotofinals.com and test your knowledge of this content. Testing yourself helps identify what you missed and strengthens your understanding and retention.
