UMEM Educational Pearls

Title: Seizures By Age - The Simple Febrile Seizure

Category: Pediatrics

Keywords: pediatrics, fever, seizure (PubMed Search)

Posted: 1/9/2025 by Kathleen Stephanos, MD (Updated: 3/14/2025)
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Simple Febrile Seizures are a very common cause for presentation to the Emergency Department. 

Up to 5% of children will have one in their lifetime, and a single febrile seizure increases risk of recurrence. 

Definition:

  • Age 6 months to 60 months (5 years)
  • <15 minutes of seizure activity
  • No focal seizure activity
  • Fever of >100.4 within 24 hours
  • 1 seizure within 24 hours
  • Return to baseline with no focal deficits
  • No history of seizures without fever (this is provoked

While not part of the formal definition, the following details are critical to obtain on history, and high risk features that should not be missed on initial evaluation:

  • Antibiotics use (within 48 hours of the seizure)
  • Vaccination status

Evaluation and Management:

Consider a finger stick

Most patients can be discharged to home after a period of observation - most use a 2-4 hour minimum. More recent literature suggests considering a longer observation period in patients who have seizures at lower core body temperatures (<39°C) or those with a history of recurrent simple febrile seizures (2 simple febrile seizures within 24 hours with return to baseline in between)

Obtain a lumbar puncture in all patients with symptoms of meningitis 

Consider a lumbar puncture, lab evaluation, and prolonged observation in patients who are under-vaccinated/unvaccinated/unknown vaccination status between 6 months and 12 months of age, or received antibiotics within the last 48 hours

References

Eilbert W, Chan C. Febrile seizures: A review. J Am Coll Emerg Physicians Open. 2022 Aug 23;3(4):e12769. doi: 10.1002/emp2.12769. PMID: 36016968; PMCID: PMC9396974.