A febrile seizure is a convulsion that occurs in a child with a high fever, typically defined as a temperature of 100.4°F (38°C) or higher. These seizures are the most common type of convulsive event in childhood, affecting approximately two to five percent of children between the ages of six months and five years. Witnessing a child lose consciousness and shake uncontrollably can be profoundly alarming for any caregiver. This information provides clear, factual details about the reality of febrile seizures and offers guidance for management.
The Direct Answer: Fatalities and Long-Term Risk
Febrile seizures are almost never fatal, and the risk of a child dying directly from one is exceedingly low. The vast majority of these seizures are benign and self-limiting; they stop on their own without intervention and do not cause lasting harm. Studies have shown that children who experience a simple febrile seizure have a mortality rate similar to that of the general population of children without a history of seizures.
The primary fear that a febrile seizure causes permanent brain damage is also largely unfounded. Simple febrile seizures do not increase the risk of intellectual disability, learning problems, or long-term neurological damage. The nervous system recovers completely once the seizure activity ceases. A small, temporary increase in mortality risk following a complex febrile seizure is often attributed to pre-existing neurological conditions that caused the seizure, not the seizure itself.
Defining Simple and Complex Febrile Seizures
Febrile seizures are categorized into two types based on their clinical features, which guides medical evaluation. A simple febrile seizure is the most common presentation. This type involves generalized tonic-clonic movements, affects the entire body, lasts for less than 15 minutes, and occurs only once within a 24-hour period.
A complex febrile seizure is less common and deviates from the simple type. Features include a seizure lasting longer than 15 minutes, multiple seizures within the same 24-hour fever episode, or a seizure that is focal (limited to one side or one part of the child’s body). Children who experience complex febrile seizures may require a more thorough medical investigation to rule out other underlying causes. While complex seizures may carry a slightly higher risk of developing a future seizure disorder, the long-term prognosis for cognitive development remains favorable for most children.
Immediate Steps During a Febrile Seizure
The most effective action a caregiver can take during a febrile seizure is to prioritize the child’s safety. Gently place the child on the floor or another soft, flat surface away from sharp objects. Position the child on their side to prevent them from inhaling vomit or saliva, which keeps the airway clear.
Immediately check the time the seizure begins, as the duration determines the need for emergency medical care. Never attempt to hold the child down or restrain their movements, and do not place anything into their mouth, including fingers or objects, as this can cause injury. After the movements stop, the child will often be sleepy, confused, or irritable, which is a normal post-seizure recovery state.
When to Seek Urgent Medical Attention
While most febrile seizures are harmless, certain signs warrant immediate medical evaluation to rule out other serious conditions. Call for emergency help if the seizure lasts for five minutes or longer, as a prolonged seizure may require medication to stop the activity. Immediate attention is also necessary if the child has trouble breathing, appears blue, or does not wake up and respond normally within a short time after the convulsions cease.
A medical professional should always evaluate a child after a first-time febrile seizure to confirm the diagnosis. Other red flags that signal the need for urgent care include signs of a more serious infection, such as extreme lethargy, a stiff neck, or persistent vomiting. Although the seizure itself is benign, evaluation ensures that the underlying illness causing the fever, such as meningitis, is not the source of the convulsion.