About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Most common seizure type in children — affects 2–5% aged 6 months to 5 years
- Simple: generalised tonic-clonic, <15 min, single in 24 h, no focal features, no post-ictal deficit
- Complex: focal, >15 min, repeated within 24 h, or post-ictal focal deficit (Todd paresis)
- Management: supportive first aid, treat source of fever, reassure parents
- Investigations: find the SOURCE OF FEVER — NOT routine neuroimaging or EEG for simple febrile seizures
- Recurrence risk ~30%. Epilepsy risk only slightly increased (2–5% vs 1% general population)
Overview
Febrile seizures are the most common type of seizure in childhood, occurring in 2–5% of children aged 6 months to 5 years. They are defined as seizures associated with fever in a child without intracranial infection, metabolic disturbance, or history of afebrile seizures. They are classified as simple (generalised, brief, single) or complex (focal, prolonged >15 min, or multiple within 24 h). The pathophysiology relates to the developing brain's increased susceptibility to seizures during rapid temperature changes. Febrile seizures are generally benign and do not cause brain damage.
Epidemiology
Febrile seizures affect 2–5% of children in the UK. Peak incidence is 12–18 months. Male:female ratio approximately 1.5:1. Risk factors include family history (strong genetic component), high peak temperature, and viral infections (particularly HHV-6 roseola, influenza). Approximately 30% of children will have at least one recurrence. Recurrence risk is highest with first episode before age 1, lower peak temperature at seizure, family history, and short duration of fever before seizure.
Clinical Features
Symptoms
Seizure associated with fever — often during the rising phase of temperature
Generalised tonic-clonic activity (simple febrile seizure)
Brief post-ictal drowsiness — child returns to normal within 1 hour
Seizure lasting >15 minutes
Focal seizure activity (one-sided jerking, eye deviation)
Multiple seizures within 24 hours
Post-ictal focal neurological deficit (Todd paresis)
Signs
Fever — identify source (URTI, otitis media, UTI, roseola common)
Child appears well after seizure — normal behaviour and neurology
Bulging fontanelle, neck stiffness, non-blanching rash (suggest meningitis — NOT simple febrile seizure)
Persistent reduced consciousness after seizure
Focal neurological signs
Investigations
First-line
Clinical assessmentFocus on identifying the SOURCE OF FEVER — examine ears, throat, chest, abdomen
UrinalysisClean catch urine — UTI is a common cause of fever in young children
ObservationsTemperature, HR, RR, SpO2, AVPU — use NICE NG143 traffic light system
Second-line
BloodsFBC, CRP, blood culture, glucose — NOT routine for simple febrile seizures but consider if source unclear or child unwell
Lumbar punctureConsider in: <12 months (meningism unreliable), meningeal signs, complex with prolonged post-ictal state, child not returning to normal
Specialist
EEGNOT indicated for simple febrile seizures — does not predict recurrence or epilepsy
NeuroimagingNOT routine — only if focal seizures, persistent neuro abnormality, or structural lesion suspected
1
Acute seizure management
- Recovery position, ensure airway patent, note time of onset
- Do NOT put anything in the mouth or restrain
- If seizure >5 min: buccal midazolam (>3 months) or rectal diazepam per APLS protocol
- If continues after 10 min: repeat benzodiazepine. After 25 min: status epilepticus protocol
2
Post-ictal assessment
- Assess for source of fever using NICE NG143 traffic light system
- Paracetamol or ibuprofen for comfort only — NOT to prevent further seizures
- Observe until child returns to normal neurological baseline
- Consider admission if: complex, child <18 months, no clear fever source, parental anxiety
3
Parental education
- Reassure: common, benign, do not cause brain damage
- Teach seizure first aid and when to call 999 (>5 min, not recovering, second seizure)
- Antipyretics do NOT prevent febrile seizures
- Recurrence risk ~30% — does NOT mean the child has epilepsy
4
Follow-up
- Simple febrile seizure: no follow-up investigations needed
- Prophylactic anticonvulsants NOT recommended for simple febrile seizures
- Rescue midazolam may be prescribed for frequent recurrences
- Complex febrile seizures: consider paediatric neurology referral
Complications
- Recurrence: ~30% after first, ~50% after second. Higher if: first episode <1 year, lower temp, family history
- Febrile status epilepticus: Seizure >30 min — risk of hippocampal injury (rare)
- Epilepsy: Risk 2–5% vs 1% general population. Higher with complex seizures, neurodevelopmental abnormality, family history of epilepsy
- Parental anxiety: Many parents believe child is dying — education essential
UKMLA Exam Tips
- 1Simple = generalised, <15 min, single in 24 h, no focal features. Complex = anything else
- 2Antipyretics do NOT prevent febrile seizures — very commonly examined
- 3EEG and neuroimaging NOT indicated for simple febrile seizures
- 4Focus on finding SOURCE OF FEVER, not the seizure
- 5LP: consider in <12 months, meningeal signs, complex with slow recovery
- 6Recurrence ~30% but epilepsy risk only slightly increased (2–5%)
- 7Most common at 12–18 months. HHV-6 (roseola) is a classic trigger
practicetest your knowledge on febrile seizuresApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — paediatrics and beyond.
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