Febrile Seizures: What to Do, What Not to Do, and Why It Is Not Epilepsy

Of all the things a parent can watch happen to their child, a febrile seizure is among the most frightening. The child is hot and unwell, then suddenly stiffens, the eyes roll, the limbs jerk, and for a minute or two the child is not there.

Most parents who have seen one describe the same thought: I thought my child was dying.

They were not. Febrile seizures look far worse than they are, and the great majority of children who have one come to no harm at all. But the response in that moment matters — and some of what families do by instinct, or by tradition, does real damage.

What a febrile seizure is

It is a seizure triggered by fever in a young child, usually between six months and five years. The developing brain in this age group is simply more prone to seizing when body temperature rises quickly. It is a reaction to fever, not a disease of the brain.

It is common. Roughly one in twenty to one in twenty-five children will have at least one. It runs in families — if a parent or sibling had them, the chance is higher.

It is not epilepsy. Epilepsy means a lasting tendency to seizures without a trigger like fever. Most children with febrile seizures never develop epilepsy, and their long-term development, intelligence and school performance are unaffected.

The height of the fever matters less than how fast it rose. This is why a seizure often happens at the very start of an illness, sometimes before the family even knew the child had a fever.

What to do — in order

Stay with the child and note the time. How long it lasts changes what happens next, and afterwards nobody remembers accurately. Look at a clock.

Put the child on their side, on the floor or a bed, away from furniture and hard edges. This lets saliva drain from the mouth.

Move objects away. Clear the space around them.

Loosen tight clothing at the neck.

Let it happen. You cannot stop a seizure by holding a child. Watch, time it, and wait.

Afterwards, expect the child to be drowsy, confused or irritable for a while. That is normal. Keep them on their side and let them rest.

Then take them to be seen — the fever needs a cause found, even if the seizure itself has passed.

What not to do — and why this part matters most

These are the things I see families do, and each one causes harm.

Do not put anything in the mouth. No spoon, no cloth, no fingers, no key. A child cannot swallow their tongue — it is anatomically impossible. What does happen is broken teeth, cut gums, objects pushed into the airway, and bitten fingers. This is the single most damaging piece of traditional advice still in circulation.

Do not hold the child down or try to stop the jerking. It does not shorten the seizure and can injure joints.

Do not make the child smell onion, a shoe, or anything else. It does nothing. It also delays putting the child in the recovery position, which does help.

Do not give water, food or medicine during the seizure. The child cannot swallow safely and fluid can enter the lungs.

Do not put the child in cold water or apply ice. Rapid cooling can cause shivering, which raises core temperature, and in a small child causes real distress.

Do not slap or shake the child to wake them.

Do not panic and drive off with the child in your arms in the middle of the seizure. Position them safely first. The two minutes you spend doing that are safer than the two minutes spent in a car with a seizing child on your lap.

Call for emergency help if

• The seizure lasts more than 5 minutes
• Another seizure follows before the child has fully recovered
• The child is having difficulty breathing, or lips turn blue
• The child does not wake up properly afterwards
• It is a first seizure — always get it assessed
• The child is under 6 months or over 6 years
• Jerking affects only one side of the body, or one limb
• There is a stiff neck, a rash that does not fade under pressure, severe headache, or the child is very drowsy — these raise the possibility of meningitis, and that changes everything

What happens at hospital

Expect two things: an assessment of the seizure, and a search for the cause of the fever.

Most of the work is finding the infection — usually a viral illness, sometimes a urine infection, throat infection or ear infection. A simple febrile seizure in a well-looking child with an obvious cause often needs no scan and no EEG.

An EEG and imaging are not routine. They are considered when the seizure was prolonged, affected one side of the body, happened more than once in the same illness, or when the child is outside the usual age range or is not recovering as expected.

Ask which category your child falls into. It is a reasonable question and you should get a clear answer.

Simple versus complex

Simple febrile seizures are the great majority. They last under 15 minutes, involve the whole body, happen once in a fever episode, and the child recovers fully. These carry a very low risk of anything further.

Complex febrile seizures last longer than 15 minutes, affect one side of the body, or recur within the same illness. These need closer assessment and a lower threshold for investigation.

The distinction matters, which is another reason to note how long it lasted.

Will it happen again?

Roughly a third of children who have one will have another, usually within a year. Recurrence is more likely if the first one happened before eighteen months, if the fever was not very high, or if there is a family history.

Recurrence is not a sign of anything getting worse. It reflects the age of the child's brain, and it stops.

Almost all children outgrow febrile seizures by around five or six years of age.

Can they be prevented?

Honestly, not reliably — and it is better you hear that than be given false confidence.

Paracetamol and ibuprofen make a feverish child more comfortable, and there is every reason to use them for that. But studies have not shown that giving them reduces the chance of a febrile seizure. Many seizures happen before anyone realised the child had a fever at all.

So treat the fever to make your child comfortable, not in the belief that you are preventing a seizure. If you have been blaming yourself for not giving medicine soon enough — please stop. It almost certainly would not have changed anything.

Daily preventive anti-seizure medication is used only in unusual cases, because the side effects outweigh the benefit for a condition children reliably outgrow.

What to say to family

Everyone will have advice, and some of it will be the spoon and the onion. It helps to have decided in advance what you will do, so you are not negotiating during a seizure.

Tell whoever looks after your child — grandparents, house help, school — three things:

1. Put the child on their side
2. Put nothing in the mouth
3. Note the time and call us

That is enough. Anything more is detail they will not remember when it happens.

A note about the fear

Parents who have watched a febrile seizure often describe lasting anxiety — checking the child at night, taking temperatures constantly, avoiding travel. That reaction is understandable and very common.

It usually settles once families understand that the event, though terrifying, is not damaging the child. If it does not settle, mention it to your paediatrician. The child's outcome is good; the parents' distress is the part that sometimes needs attention, and there is no shame in saying so.

Written by Dr. P. K. Jha, MBBS, MS, MNAMS, M.Ch (Neurosurgery, AIIMS New Delhi), DMC Reg 13809. Consultant Neurosurgeon with over 30 years treating brain and spine patients. Practising at Neuro Care India, Gaur City 1, Greater Noida.

This article is educational and is not a substitute for a clinical assessment. A first seizure of any kind must be assessed by a doctor. If a seizure lasts more than 5 minutes, treat it as an emergency.