Febrile convulsions

R56.0

DESCRIPTION

A febrile convulsion is a seizure occurring in a child between the ages of 3 months and 6 years of age in association with a significant fever in the absence of an intracranial infection. These are the most common type of seizures in children of this age. However, the diagnosis requires the exclusion of other causes of seizures.

LoEIII [13]

Febrile convulsions can be simple or complex.

Simple febrile convulsions:

  • are generalised
  • occur once per illness
  • always last for < 15 minutes (typically lasting 1–2 minutes)
  • are not associated with any neurological deficit
  • are self-limiting

Complex febrile seizures:

  • last > 15 minutes; or
  • are recurrent within the same febrile illness; or
  • have a focal onset.

Children with febrile convulsions have a good prognosis, and very rarely develop epilepsy

If convulsing:

Children

  • Midazolam, buccal, 0.5 mg/kg/dose as a single dose. See Paediatric dosing tool.
    • Use midazolam for injection 5 mg in 1 mL undiluted.
    • Draw up the required volume in a 5 mL syringe.
    • Remove needle then administer midazolam into the buccal cavity (between gum and cheeks).
    • Note: Buccal midazolam should not be used in infants < 6 months of age.

OR

  • Diazepam rectal, 0.5 mg/kg/dose as a single dose. See Paediatric dosing tool.
    • Use diazepam for injection 10mg in 2 mL undiluted.
    • Draw up the required volume in a 2 mL syringe.
    • Remove needle then insert the whole barrel of the lubricated syringe into the rectum and inject the contents.
    • Remove syringe and hold buttocks together to minimise leakage.
    • Maximum dose: 10 mg in 1 hour.
    • May be repeated after 10 minutes if convulsions continue.
    • Expect a response within 1–5 minutes.

If no response after two doses of midazolam or diazepam, manage as Status epilepticus. See: Seizures and status epilepticus.

Note:

  • Look for a cause of the fever.
  • Always exclude meningitis. See: Meningitis.

GENERAL MEASURES

Reassure parents and caregivers.

MEDICINE TREATMENT

Treat the underlying cause.

For symptomatic relief:

  • Paracetamol, oral, 15 mg/kg/dose 6 hourly when required. See Paediatric dosing tool.
    • Paracetamol has no effect on seizure prevention.

REFERRAL

  • All febrile convulsions except where:
    • the diagnosis of recurrent simple febrile seizures has been well established
      AND
    • the child regains full consciousness and function immediately after the seizure
      AND
    • meningitis has been excluded See: Meningitis.
  • Complex convulsions.