AAP febrile seizure: what parents should know

The child may become stiff, jerk, lose awareness or have eyes that roll upward. The episode is frightening to witness, but your immediate priorities are preventing injury, watching breathing and noting how long it lasts.

Febrile seizures occur in childhood during an illness with fever. They are different from a seizure caused by low blood glucose, a brain infection or another neurological problem, so a clinician considers the child's age, examination, recovery and features of the event.

Sleepiness can follow a seizure, but the child should be observed closely as awareness returns. A clear description or safely recorded video may help the clinician distinguish rhythmic jerking from shivering, fainting or other movements.

Place the child on their side on a safe surface, move hard objects away, loosen tight clothing around the neck and start a timer. Do not restrain the movements, put anything in the mouth, or give food, drink or medicine until the child is fully alert.

Once the seizure stops, check breathing and stay with the child. Fever medicine can improve comfort after swallowing is safe, but it does not treat an active seizure. Arrange medical advice after a first fever-associated seizure even if recovery appears complete.

Call emergency services if the seizure lasts longer than five minutes, breathing is difficult, the child turns blue, movements affect only one side, another seizure follows, serious injury occurs, or the child does not regain awareness as expected.

Urgent assessment is also needed for a stiff neck, a non-blanching rash, persistent vomiting, marked weakness, severe headache or an unusually difficult-to-wake child. These features can accompany serious illness such as meningitis and should not be attributed to fever alone.

Ask what may have caused the fever, whether the event had features needing further investigation, how to respond if it happens again and whether a prescribed rescue medicine is appropriate. Confirm its exact dose and when it should be used.