Febrile Convulsions: What to Do, and What It Means Afterwards

Almost every parent who has watched one has thought, in that moment, that their child was dying. The stiffening, the jerking, the eyes rolling back, the blue lips, and the terrible fact that your child does not respond when you call their name.

If that has just happened in your house and you are reading this at two in the morning, the two things worth knowing first are these. It is far more common than you think. And the best long-term study ever done on these children is genuinely reassuring — the detail is further down this page.

We are not a medical service. This is a doctor's territory from beginning to end, and this page is here because families ask us about it afterwards, usually worried about their child's development.

What a febrile convulsion is

A febrile convulsion — a fever fit — is a seizure that happens in a young child because of a rise in body temperature, usually from an ordinary infection. The brain of a young child is more excitable than an older one's, and in some children a rapid rise in temperature is enough to trigger a seizure.

It is not epilepsy. Epilepsy means recurring seizures that are not provoked by something like a fever. A febrile convulsion is provoked, by definition, and most children who have one never have anything like it again.

It is also not caused by how high the fever gets. It is more often the speed of the rise than the height, which is why a convulsion can be the very first sign that a child is unwell — before you knew there was a fever at all. This matters, because parents frequently blame themselves for not checking a temperature sooner.

The NHS describes the typical picture: children usually become stiff, may have jerking movements, become unconscious, do not respond or look at you when you speak, may be sick or wet themselves, and may be sleepy, irritable or confused for up to an hour afterwards. They usually last two to three minutes, and it is rare for one to last more than ten. They usually affect children between six months and six years old.

What to do while it is happening

Read this now, while nothing is happening, because nobody takes in instructions during one.

Do

• Check the time it starts. This is the single most useful thing you can do, and almost nobody does it — the length of the seizure changes what happens next, and every parent's estimate afterwards is far longer than the reality.
• Protect their head with your hands or something soft.
• Move anything dangerous out of the way.
• Note the time it stops.
• Afterwards, put your child on their side in the recovery position, and check there is nothing in their mouth or throat that could affect their breathing.
• Stay with them. They will be confused and sleepy for a while and that is expected.

Do not

• Do not put anything in your child's mouth. Not a spoon, not your fingers, not cloth. A child cannot swallow their tongue, and this causes real injuries every year.
• Do not try to hold them still or restrain the movements.
• Do not move them unless they are somewhere dangerous.
• Do not try to bring the temperature down by undressing them or sponging them with cold water. It does not stop the seizure and it can make a child more distressed.
• Do not try to give medicine, water or anything by mouth during a seizure.

Get emergency help immediately — Rescue 1122, or the nearest hospital — if

• This is your child's first seizure
• The seizure lasts more than five minutes
• Your child is having difficulty breathing
• The stiffness and twitching are on only one side of the body
• Your child is more sleepy than usual for more than an hour after it stops
• There is more than one seizure within 24 hours

If your child is still fitting or is unconscious, do not put them in a car and drive. Call for an ambulance and stay with them.

And go regardless of the list above if your child has a rash that does not fade when you press a glass against it, an unusually stiff neck, a severe headache, will not wake properly, or simply looks much more unwell than any previous illness. Those point away from a simple febrile convulsion and towards something that needs looking at urgently.

What the long-term research found

This is the question every parent asks in the days afterwards, usually quietly: has this damaged my child's brain?

The most important study on this was published in the New England Journal of Medicine, and its design is what makes it worth trusting. Earlier research that produced frightening findings was hospital-based — it studied the children who ended up in hospital, who are by definition the more severe cases. This study was population-based instead.

Researchers identified 398 children with febrile convulsions among 14,676 children in a national UK study of everyone born in a single week. They assessed all of them comprehensively at the age of ten, using questionnaires, standardised tests and formal testing across academic progress, intelligence and behaviour, and compared them with the rest of the cohort.

The result: of 102 separate measures, only four differed significantly between the children who had febrile convulsions and those who had not — which is no more than you would expect by chance alone.

Three further details from the same study are worth having:

• The finding held for children with simple febrile convulsions and for those with complex ones, analysed separately.
• Children who had recurrent febrile convulsions had outcomes similar to children who had only one.
• The children studied included 287 with simple and 94 with complex convulsions, so this is not a study of the mildest cases only.

That is about as reassuring as evidence in this area gets, and it is the answer to the fear most parents are carrying. It is not a promise about any individual child, and it does not replace what your own doctor tells you about your own child — but if you have been lying awake imagining long-term damage, the population-level evidence does not support that fear.

What usually happens next

Most children who have one febrile convulsion never have another. A proportion do, and recurrence is more likely in children who were young at their first one, whose seizure happened at a relatively low temperature, or where there is a family history — which is why doctors ask about all three.

Having febrile convulsions does slightly raise the chance of developing epilepsy later compared with children who never had one, but the great majority of children who have febrile convulsions do not go on to develop epilepsy. Your doctor is the person to discuss your child's particular risk with, because it depends on features of the seizure and the child that a webpage cannot know.

Regular fever medicine given to prevent a convulsion does not reliably work, which surprises most families. Treat a fever because it makes your child more comfortable, not in the belief that it will prevent a seizure. Discuss any prevention plan with your doctor rather than deciding it yourself.

Living with it afterwards

The part almost nobody addresses is what it does to the family, and it is often larger than what it does to the child.

Parents describe not sleeping properly for months, checking a sleeping child repeatedly through the night, refusing to let anyone else look after them, and panic at the first sign of any illness. Some describe genuine flashbacks to the event. None of that is an overreaction — you watched your child stop responding to you — but it is worth naming, because it is treatable and because families rarely mention it.

A few practical things help:

• Teach everyone who looks after your child what to do. Grandparents, the maid, an older sibling, the school. Written down, in simple steps, kept somewhere findable. Most of the terror of a second one is the fear that it will happen when you are not there.
• Tell the school or nursery, in writing, including what to do and who to call.
• Keep a note of any episode: date, how long it lasted, what it looked like, which side, temperature if known, how long recovery took. Doctors ask precisely these things and memory is unreliable.
• Do not let it shrink your child's life. Children who have had febrile convulsions do not need to be wrapped up, kept home or treated as fragile, and being treated as fragile has its own cost.

When to look further

Febrile convulsions themselves do not cause developmental problems — that is what the study above establishes. But two things are worth watching for, and they are why families sometimes end up with us.

First, if your child was already showing a developmental difference before the convulsions, that difference is still there and still deserves attention. It is easy for everything to get attributed to the fits, and for a genuine speech or developmental delay to go unassessed for a year because everybody is focused on the seizures.

Second, if you notice something new afterwards — words that have gone, skills that have been lost, a change in how your child interacts — do not assume it is the aftermath of the seizure and wait. Loss of skills a child previously had is always worth investigating properly, whatever the apparent explanation. Our page on developmental delay covers what that assessment involves, and our developmental checklist is a reasonable place to start writing down what you are seeing.

And if what your child has been left with is fear rather than any developmental change — a child who has become clingy, frightened of doctors, or anxious about being unwell — that is real and it responds well to help. See childhood anxiety.

Where we fit

Not in the medical part at all. The seizures, the investigations and any prevention plan belong with your doctor, and if what you are describing sounds like a seizure we will say so and send you there before we do anything else.

Where we help is afterwards: assessing a child whose development was already a question before this happened, checking that skills are where they should be if you are not sure, and working with the anxiety — the child's, and frequently the parents'.

A consultation is Rs 1,500 and lasts up to 50 minutes, we work in Urdu or English, and you do not need a referral.

Sources

• Verity CM, Greenwood R, Golding J. Long-term intellectual and behavioral outcomes of children with febrile convulsions. New England Journal of Medicine. PubMed 9624192
• Febrile seizures — NHS, for what to do and when to seek emergency help.
• Emergency number 1122 — Emergency Services Department, Government of the Punjab.