Executive summary
- Typical febrile seizure: seizure with fever in a neurologically normal child, usually between 6 months and 5 years, with no evidence of CNS infection.
- The real job is not the convulsion itself — it is excluding serious causes such as meningitis, encephalitis, sepsis, metabolic disturbance, or epilepsy mimics.
- Routine prophylactic medicines are not recommended after a febrile seizure.
Acute first aid and red flags
- First aid: place the child in a safe position, protect from injury, do not restrain, and do not put anything in the mouth.
- Emergency transfer is needed if the seizure is prolonged, recurrent in the same illness, associated with persistent impaired consciousness, focal neurology, cardiorespiratory compromise, or red flags for serious infection.
- Red flags to actively look for: neck stiffness, photophobia, petechial/non-blanching rash, bulging fontanelle, prolonged post-ictal state, focal deficit, or markedly reduced level of consciousness.
After the event
- Simple febrile seizure: generalised, short, single, and full recovery. Complex features include focality, recurrence in the same illness, prolonged seizure, or incomplete recovery.
- Most management is supportive: identify and manage the source of fever, advise parents on seizure first aid, and give clear return precautions.
- Do not use antipyretics to prevent recurrence of febrile seizures; paracetamol or ibuprofen may improve comfort but do not reliably prevent another convulsion.
- Consider specialist assessment if the history is atypical, the child is under 6 months, or the event may not fit a simple febrile seizure pattern.
Frequently asked questions
What is the most important differential diagnosis?
Meningitis/encephalitis and other serious febrile illnesses. The presence of fever does not by itself make the diagnosis “just a febrile convulsion”.
Do paracetamol or ibuprofen stop febrile seizures coming back?
No. They may help the child feel more comfortable, but they are not recommended as a strategy to prevent seizure recurrence.
When should I escalate after a febrile seizure?
Escalate if there are complex features, red flags for serious infection, incomplete recovery, recurrent seizures in the same illness, or diagnostic uncertainty.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.