The sudden onset of a febrile seizure in a child is a terrifying experience for any parent, often leading to the question of whether the event could be fatal. Death from a febrile seizure is extremely rare, as the vast majority of these events are harmless and benign. Febrile seizures are the most common type of seizure in early childhood, occurring in 2% to 5% of children. They do not typically result in long-term health problems or indicate a serious underlying neurological disorder.
What Exactly Are Febrile Seizures?
A febrile seizure is a convulsion in a young child caused by a fever, without a central nervous system infection like meningitis. These events occur in children between six months and five years old, often associated with a temperature of 100.4°F (38°C) or higher. The seizure often happens during the first day of an illness as the child’s temperature is rapidly rising.
These seizures are classified into two types: simple and complex. Simple febrile seizures are the most common, lasting less than 15 minutes, generalized (shaking the whole body), and not recurring within 24 hours. Complex febrile seizures last longer than 15 minutes, may only affect one side of the body (focal), or occur more than once within 24 hours.
The Direct Answer: Fatality Risk and Safety
Febrile seizures are rarely fatal because the seizure mechanism is self-limiting and does not typically cause sustained respiratory or brain damage. The seizure activity usually resolves spontaneously within minutes. Most simple febrile seizures last only a few seconds to a few minutes, well under the 15-minute threshold. The low mortality rate for children experiencing simple febrile seizures is statistically similar to the death rate in the general population.
Any slight increase in mortality risk observed in subgroups is attributed to pre-existing neurological conditions or complex febrile seizures, not the seizure itself in an otherwise healthy child. The minor risks during the seizure event are primarily related to external injury from falling or, rarely, aspiration if the child vomits.
Immediate Steps During a Seizure
The primary objective during a febrile seizure is to keep the child safe and prevent injury, as the seizure cannot be stopped once it begins. Gently move the child to the floor or ground, away from hard or sharp objects that could cause harm. Positioning the child on their side prevents choking or aspiration from saliva or vomit and keeps the airway open.
Time the seizure’s duration from start to finish, and loosen any tight clothing around the child’s neck. Never attempt to restrain the child’s movements or place anything into their mouth, as this can cause injury to the child’s teeth, gums, or fingers. Call emergency medical services (911) if the seizure lasts longer than five minutes, if the child has difficulty breathing or turns blue, or if the child appears extremely ill after the seizure stops.
Long-Term Outcomes and Recurrence
Febrile seizures do not cause brain damage, intellectual disability, or learning problems in previously healthy and developmentally normal children. The long-term risk of developing epilepsy, a condition involving recurrent unprovoked seizures, is low for children who have only experienced simple febrile seizures, estimated at about 2%. This risk is modestly higher, between 6% and 8%, for those who have experienced complex febrile seizures.
Recurrence is common, with approximately one in three children experiencing another seizure, typically within one or two years of the first event. Factors increasing the likelihood of recurrence include a young age at the time of the first seizure, a family history of febrile seizures, or a seizure that occurred with a relatively low fever.