Febrile Convulsion in Children: What Parents Should Do During a Fever Seizure

Seeing your child suddenly become stiff, shake, roll their eyes or stop responding during a fever can be terrifying. This is commonly called a febrile convulsion, febrile seizure or “fever fit”. Although the episode can look dramatic, most febrile convulsions are brief and do not cause long-term harm. However, parents should know what to do in the moment, what not to do, and when urgent medical care is needed.

What is a febrile convulsion?

A febrile convulsion is a seizure that happens in a young child during a fever, usually as part of an infection. It most commonly affects children between about 6 months and 6 years of age. Clinically, doctors also need to consider and exclude other causes of seizure, such as meningitis, encephalitis, electrolyte problems or a history of seizures without fever.

Febrile convulsions are often linked to common childhood infections, such as viral upper respiratory tract infections, influenza, roseola, gastroenteritis, ear infections or urinary tract infections. Importantly, a febrile convulsion does not always happen only when the temperature is extremely high. Some children have a seizure early in the illness, when the temperature is rising quickly and before parents realise the child has a fever.

What does a febrile convulsion look like?

During a febrile convulsion, a child may suddenly lose awareness, become stiff or floppy, have jerking or twitching movements of the arms and legs, roll their eyes back, dribble saliva, make unusual breathing sounds, vomit or pass urine. Some children may look red, pale or briefly bluish around the lips. After the seizure stops, the child may be sleepy, irritable or confused for a short period before gradually returning to normal.

Doctors usually describe febrile seizures as either simple or complex. A simple febrile seizure is generalised, lasts less than 15 minutes, does not recur within the same illness and is followed by full recovery. A complex febrile seizure may last longer, affect only one side of the body, recur during the same fever episode or be followed by prolonged altered consciousness. Complex features do not automatically mean a serious disease, but they do mean the child needs more careful medical assessment.

What should parents do during a febrile convulsion?

The most important thing is to keep your child safe while the seizure runs its course. Try to stay calm and note the time the seizure starts. Place your child on a safe, flat, low surface and gently turn them onto their side. Move away hard, sharp or hot objects nearby. If possible, observe whether the shaking is affecting the whole body or only one side, how long it lasts, and whether the child has breathing difficulty. If it is safe to do so, a short video can help the doctor understand what happened later.

Do not hold your child down. Do not put fingers, spoons, towels, medicine, water or any object into the mouth. Children do not swallow their tongue during a seizure, and putting something in the mouth can cause choking or injury. Do not try to give fever medicine while the child is unconscious or convulsing. Do not put your child in a cold bath or use aggressive cooling methods during the seizure.

When should you call an ambulance or go to A&E?

In Hong Kong, call 999 if your child is still convulsing, unconscious, having difficulty breathing or appears seriously unwell. GovHK states that 999 should be used when police, fire services or an ambulance are needed.

You should seek urgent medical care if this is your child’s first seizure, the seizure lasts more than 5 minutes, your child has trouble breathing, the seizure affects only one side of the body, your child remains unusually sleepy or confused after the seizure, there is more than one seizure within 24 hours, or your child appears very unwell. Warning signs such as neck stiffness, persistent vomiting, severe headache, non-blanching rash, poor feeding, dehydration, persistent drowsiness or abnormal behaviour also require prompt medical assessment.

If your child is actively convulsing or unconscious, do not drive them yourself. Call emergency services and wait for help.

What causes febrile convulsions?

Most febrile convulsions are associated with common infections, especially viral illnesses. In Hong Kong, children frequently develop fever from upper respiratory tract infections, influenza-like illness, gastroenteritis, hand-foot-and-mouth disease, roseola, tonsillitis, otitis media or urinary tract infections. The seizure itself is usually a reaction to the fever or rapid rise in body temperature rather than a sign that the infection has already spread to the brain.

Some children are more likely to have febrile convulsions because of age and family tendency. Younger children are more likely to have another febrile seizure after the first episode, and recurrence risk varies with age and family history.

Vaccines can occasionally cause fever, and fever can rarely be associated with febrile seizures. The Hong Kong Centre for Health Protection notes that an increased risk of febrile seizures has been reported in children under 2 years old receiving MMRV, while no association was found for children aged 4–6 years receiving MMRV. Parents should not stop routine vaccination on their own; instead, discuss the child’s history with a doctor if there has been a previous seizure after vaccination or a complex medical background.

How will a doctor assess a child after a febrile convulsion?

A doctor will focus on two questions: first, whether the event was likely to be a febrile convulsion; second, what caused the fever. The assessment usually includes a detailed history of the fever, seizure duration, seizure pattern, recovery time, previous episodes, vaccination history, medications, family history and any signs of serious infection.

The physical examination may include checking temperature, hydration, throat, ears, chest, abdomen, skin, neck stiffness and neurological status. Depending on the situation, the doctor may consider urine testing, viral testing, blood tests or other investigations. For a typical simple febrile seizure in a child who has returned to normal, routine brain scans, EEG or extensive blood tests are usually not needed unless the clinical picture suggests another problem.

Further investigation or paediatric referral may be needed if the seizure is prolonged, focal, recurrent during the same illness, associated with persistent altered consciousness, occurs in a very young infant, or if there are signs of meningitis, encephalitis, sepsis, dehydration or another serious condition.

Treatment and home care

Most febrile convulsions stop by themselves. Treatment usually focuses on the underlying cause of the fever and keeping the child comfortable. Fever medicines such as paracetamol or ibuprofen may help reduce discomfort, but they do not reliably prevent another febrile seizure. Antibiotics are only useful when a bacterial infection is suspected or confirmed; they are not needed for most viral infections.

Long-term anti-seizure medication is not routinely recommended for simple febrile convulsions. In selected children with prolonged or recurrent seizures, a doctor may prescribe an emergency rescue medicine and teach parents exactly when and how to use it. This should only be used under medical guidance.

At home, encourage fluids, rest and light clothing. Avoid aspirin in children unless specifically advised by a doctor. Keep a record of fever episodes, seizure duration, associated symptoms and any medications given. This can help your doctor identify patterns and decide whether further assessment is needed.

Can febrile convulsions be prevented?

There is no guaranteed way to prevent febrile convulsions. Good hand hygiene, avoiding close contact with sick individuals where possible, keeping vaccinations up to date, and seeking timely care for significant infections can reduce illness burden, but they cannot fully remove the risk. Fever medicines can improve comfort but should not be relied on as seizure prevention.

Parents often feel anxious after a first febrile convulsion. It is helpful to have a written plan: what to do during a seizure, when to call 999, what fever medicine dose is appropriate for the child’s weight, and when to book a follow-up consultation.

How a family doctor can help

During an active seizure, especially a first seizure, prolonged seizure or seizure with breathing difficulty, emergency care is the priority. Once the child is stable, a family doctor can help assess the cause of fever, check for common infections such as ear infection, throat infection, chest infection, gastroenteritis or urinary tract infection, and decide whether medication, testing or referral is needed.

A family doctor can also explain recurrence risk, review vaccination records, provide fever care guidance, advise when the child can return to school or childcare, and arrange paediatric referral if the episode has complex features. For stable follow-up after recovery, an in-person consultation or appropriate future teleconsultation may be useful. However, teleconsultation is not suitable for a child who is actively convulsing, unconscious, breathing abnormally or having their first seizure.

FAQ

Does a febrile convulsion cause brain damage? Most short, simple febrile convulsions do not cause brain damage or long-term developmental problems.

Is a febrile convulsion the same as epilepsy? No. Epilepsy means repeated seizures without fever or another acute trigger. Febrile convulsions are fever-related seizures in young children.(nhs.uk)

Should I give fever medicine immediately to prevent another seizure? Fever medicine may make your child more comfortable, but it does not reliably prevent febrile seizures. Use the correct dose based on age and weight, and seek medical advice if unsure.

Does my child need a brain scan or EEG? Not usually after a typical simple febrile seizure if the child fully recovers and the examination is reassuring. Tests are considered when there are atypical or concerning features.

Medical disclaimer: This article is for general health education only and does not replace personalised medical assessment. If your child has a seizure, breathing difficulty, persistent fever, unusual drowsiness, worsening symptoms or any worrying signs, seek medical care promptly. In an emergency in Hong Kong, call 999 or attend an Accident & Emergency Department.