Febrile Convulsion

Advice for parents and caregivers

What are febrile convulsions?

A febrile convulsion is a fit or a seizure that is caused by a high temperature. It is not known exactly why some children have febrile convulsions. Children are often brought to the Emergency Department having had a febrile convulsion. It happens to approximately one in twenty children and most commonly in children under the age of five.

Young children can suffer from various common illnesses and infections such as colds, ear infections, tonsillitis, kidney or urine infections. These can cause very high temperatures and occasionally lead to a febrile convulsion.

Convulsions are not caused by children becoming hot from being active or by hot weather.

When should you worry?

If your child has any of the following:

  • Is under 1 year of age 

  • The first time your child has had a fit (seizure) 

  • Has a fit that lasts longer than 5 minutes 

  • They have one fit after another without being awake in between 

  • They are seriously injured during the fit 

  • Remains drowsy or confused more than an hour after their fit 

  • Has weakness of the arms or legs, visual difficulties (double vision) or difficulty speaking after the fit has stopped 

  • They have trouble breathing after the fit has stopped 

  • Breathing very fast or breathing that stops or pauses 

  • Working hard to breathe, drawing in of the muscles below the rib, unable to talk or noisy breathing (grunting) 

  • Becomes pale, blue, mottled and/or unusually cold to touch 

  • Develops a rash that does not disappear with pressure and seems unwell (see the ‘Glass Test’)
You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Has another fit (less than 5 minutes) within the same illness 

  • Breathing a bit faster than normal or working a bit harder to breathe 

  • Noisy breathing (stridor) only when upset 

  • Dry skin, lips, tongue or looking pale 

  • Not had a wee or wet nappy in last 8 hours 

  • Poor feeding in babies (less than half of their usual amount) 

  • Irritable (unable to settle them with toys, TV, food or hugs even after their fever has come down) 

  • A temperature 39°C or above in babies 3-6 months 

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors) 

  • Getting worse or you are worried about them 

You need to contact a doctor or nurse today

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

 

If none of the above features are present:

Seizure lasting less than 5 minutes with full recovery in a child with previous febrile convulsions or known epilepsy.

  • Watch them closely for any change and look out for any red or amber symptoms  

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

Most febrile convulsions last between 1 to 5 minutes.

  • Your child will look hot and flushed
  • They may become dazed and confused
  • They may fall to the floor
  • Your child's muscles will tighten; this may cause them to moan or cry out
  • Your child may hold their breath for up to 30 seconds. They might look a bit blue in the face
  • The muscles in their arms, legs and body may twitch and shake
  • Their eyes may roll backwards
  • Many children lose control of their bowel or bladder or may bite their tongue
  • Your child may be sleep afterwards

No, your child will be unconscious (not be aware of their surroundings) and unaware of what is happening. You may find the convulsion much more upsetting than it is for your child.

Febrile convulsions are unlikely to cause any harm or damage, but rarely injuries can occur during a convulsion (if your child falls against a hard surface, for example).

No. Epilepsy means repeated convulsions, usually without a high temperature. Epilepsy normally affects older children and adults.

Many children never have more than one episode, but if your child was over the age of one year when they had the febrile convulsion they have a one in three chance of it happening again. If your child is under one, the chance or having another convulsion is higher than this.

Febrile convulsions usually occur at the start of an illness, when your child's temperature is rising rapidly.

  • Children lose heat through their skin, so remove any extra clothing they are wearing. Your child may be shivering due to being hot rather than cold, but this does not mean that they need covering up. Stripping your child down to their underwear or nightwear is ideal, but avoid fleecy pyjamas
  • Encourage your child to drink lots of fluids or to have frequent feeds if they are breastfed. Clear fluids such as water are ideal for older children
  • Think about giving your child paracetamol or ibuprofen, especially if they are very hot or uncomfortable. You can give these two painkillers together

Paracetamol can be given every 4 hours but do not give more than four doses in 24 hours.

Ibuprofen can be given every 6-8 hours. Do not give more than 3 doses of ibuprofen in 24 hours.

Things you should not do:

  • Do not wrap your child in a blanket
  • Do not put extra clothes on your child
  • Do not take your child into bed with you, the heat from your body could increase their temperature. Similarly, if you need to bathe your child make sure the bath water is not too warm
  • Do not use a flannel or sponge to cool your child with water. This does not help reduce a fever

  • Stay calm. Remember that a convulsion is unlikely to cause any harm or damage. Make a note of the time the convulsion started
  • Lay your child on their side with their head slightly tipped back, to keep their airway clear (see picture and link to video below). Move any hard or sharp objects away from your child
  • Loosen any clothing, especially around their neck
  • Ensure their mouth is empty but never force anything between their teeth or gums, especially not your fingers, as they may suddenly clench their teeth. If they spit anything out, wipe it away from their lips
  • If your child holds their breath for longer than 30 seconds, dial 999 immediately
  • If the convulsion lasts for longer than 5 minutes, call 999 immediately
  • If the convulsion is short, call your GP or 111 as soon as possible for advice

 

Click here for a video on how to put someone into the recovery position: First aid - Recovery position - NHS (www.nhs.uk)