Febrile Seizures in Babies and Toddlers: What to Do, What They Mean, and the Long-Term Outlook

Witnessing a febrile seizure is one of the most frightening experiences a parent can have. A child who was simply unwell moments before suddenly becomes rigid or floppy, their eyes roll back, their limbs jerk uncontrollably, and they are entirely unresponsive. It looks like a crisis. Understanding what is actually happening — and what the evidence tells us about outcomes — transforms this experience from overwhelming terror into something, while still distressing, that can be managed with knowledge.

What Is a Febrile Seizure?

A febrile seizure (also called a febrile convulsion) is a seizure triggered by a rapid rise in body temperature, most commonly associated with a viral illness. They occur in children aged six months to six years, with the peak incidence between eighteen months and two years.

Febrile seizures are common. Approximately 2 to 5 per cent of all children in the UK will have at least one febrile seizure. They are one of the most common neurological events in childhood.

There are two types:

Simple febrile seizures. These are the most common form (about 70–75% of all febrile seizures). They last less than 15 minutes, involve convulsive movements of the whole body (generalised), and do not recur within 24 hours. The vast majority of febrile seizures are simple.

Complex febrile seizures. These last longer than 15 minutes, may affect only one part of the body (focal), or may occur more than once within 24 hours. Complex febrile seizures warrant more thorough investigation, though the majority are still not associated with serious underlying pathology.

What to Do During a Febrile Seizure

If your child is having a seizure:

1. Stay as calm as you can and stay with your child throughout.
2. Time the seizure. Note when it started — this is important information for emergency services and clinicians.
3. Put your child in the recovery position — on their side, with their head tilted back slightly to keep the airway clear. This prevents them from choking if they vomit.
4. Do not put anything in their mouth. Never place your fingers, a spoon, or any object in a child's mouth during a seizure. The risk of injury to you and your child is significant, and there is no risk of swallowing the tongue.
5. Do not try to restrain the movements. Move dangerous objects away from the child but do not hold their limbs still.
6. Call 999 if: the seizure is the first one your child has had (even if it has stopped), the seizure lasts longer than five minutes, your child does not recover normally after the seizure, or you are concerned for any reason.

After the seizure, your child will likely be drowsy and confused — this is the "post-ictal period" and is normal. They may sleep for some time. Once they have recovered enough, they should be seen by a doctor to identify the underlying cause of the fever.

Do Fever Reducers Prevent Febrile Seizures?

This is one of the most important evidence-based points for parents to understand: giving paracetamol or ibuprofen to a child with a fever does not prevent febrile seizures.

Multiple well-designed studies, including a Cochrane review, have found no significant reduction in febrile seizure recurrence in children who receive fever-reducing medication compared to those who do not. The belief that managing fever prevents febrile seizures is widespread among parents and some healthcare workers, but the evidence does not support it.

This matters because parents often feel guilt that they did not manage the fever aggressively enough, or anxiety that every fever must be medicated urgently to prevent a seizure. Neither response is warranted. Paracetamol and ibuprofen are appropriate for making a feverish child more comfortable, but they should not be given with the aim of preventing seizures.

Will It Happen Again?

Approximately one-third of children who have had a febrile seizure will have another one during a subsequent fever. The risk is higher if the first seizure occurred before fifteen months of age, if the seizure occurred with a relatively low fever, or if there is a family history of febrile seizures.

However, the majority of children who have febrile seizures do not have more than one or two. Most outgrow the tendency by age six.

What Is the Long-Term Outlook?

This is the most important question, and the answer is overwhelmingly reassuring.

Simple febrile seizures do not cause brain damage. There is no evidence that even prolonged simple febrile seizures cause measurable neurological damage in otherwise healthy children.

The risk of developing epilepsy after simple febrile seizures is very low. The general population risk of epilepsy is approximately 1 to 2 per cent. In children who have had simple febrile seizures, this risk rises to approximately 2 to 3 per cent — a small increase, and still a low absolute risk.

For complex febrile seizures (particularly prolonged ones, called "febrile status epilepticus"), the evidence is more nuanced. There is association with a slightly higher risk of later temporal lobe epilepsy in a small subset of children. However, whether the seizure itself causes the subsequent epilepsy, or whether both reflect an underlying vulnerability, is still debated in the research literature.

Academic and cognitive outcomes after simple febrile seizures are normal. Studies following children into adulthood after febrile seizures show no significant differences in cognitive function, educational attainment, or behavioural outcomes compared to children who did not have seizures.

Talking to Your GP and Health Visitor

After a first febrile seizure, your GP should assess your child and identify the cause of the fever. If there is any concern about meningitis or other serious infections, a more thorough assessment will be arranged.

Your GP may refer you to a paediatric clinic for a follow-up appointment, particularly if the seizure was complex. For simple febrile seizures, no further investigation is routinely required in an otherwise healthy child.

Ask your GP about what to do in the event of a recurrence, and whether buccal midazolam (an emergency seizure medication administered in the cheek) is appropriate to have at home given your child's individual history. For most children with simple febrile seizures, it is not needed — but for children with longer or more complex episodes, it may be recommended.