Febrile seizures

A febrile convulsion is a seizure that usually occurs from 3 months to 6 years of age—it is associated with fever (more than 38oC) without concurrent acute intracranial disease, metabolic disturbance or central nervous system infection. Reducing the child's temperature (eg with paracetamol or ibuprofen) does not stop febrile seizures or prevent subsequent febrile seizures.

Most febrile seizures are brief and end within 1 to 3 minutes without drug treatment. Give supportive care. If the seizure lasts more than 5 minutes, use:

1 midazolam 0.2 to 0.3 mg/kg (up to 10 mg) buccally or intranasally. Repeat once 10 minutes later if seizure continues1 febrile seizures midazolam    

OR

1 midazolam 0.15 to 0.2 mg/kg (up to 10 mg) intramuscularly. Repeat once 10 minutes later if seizure continues. midazolam    

If the seizure continues 10 minutes after the second dose of midazolam, treat with an antiepileptic drug as in Step 2 for status epilepticus.

Most children do not need antiepileptic drug treatment to prevent recurrent febrile seizures. If needed, phenobarbital (phenobarbitone) or sodium valproate, but not phenytoin or carbamazepine, may be used.

1 Midazolam solution for injection (hydrochloride salt) can be given buccally or intranasally and may be provided under expert advice to parents and carers who have been trained in its use. Fact sheets that explain the method are available (eg from the Royal Children's Hospital Melbourne).Return