Pediatric Febrile Seizure (AAP 2011)

Algorithm Steps

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   Start

   Pediatric Febrile Seizure

   Seizure with fever in child 6-60 months

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      Action

      Definition & Classification

      Febrile seizure in neurologically healthy child

      • FEBRILE SEIZURE:
      • Seizure + fever (≥38°C) in child 6-60 months
      • No CNS infection, metabolic cause, or prior afebrile seizures
      • SIMPLE FEBRILE SEIZURE:
      • • Generalized tonic-clonic
      • • Duration <15 minutes
      • • Does not recur within 24 hours
      • COMPLEX FEBRILE SEIZURE:
      • • Focal features
      • • Duration ≥15 minutes
      • • Recurs within 24 hours
      • • Postictal Todd's paralysis
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         Decision

         Simple or Complex?

         Classify the febrile seizure

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            Action

            Simple Febrile Seizure

            Benign condition - reassurance

            • NO ROUTINE WORKUP REQUIRED:
            • • LP NOT recommended (if immunized, no meningeal signs)
            • • EEG NOT recommended
            • • Neuroimaging NOT recommended
            • • Blood tests NOT routinely needed
            • Identify and treat source of fever
            • Focus on reassuring parents
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               Warning

               When to Consider LP

               AAP recommendations

               • STRONGLY CONSIDER LP IF:
               • • Meningeal signs present
               • • Infant 6-12 months not fully immunized (Hib, PCV)
               • • Pretreated with antibiotics
               • CONSIDER LP IF:
               • • Provider has high suspicion for CNS infection
               • LP NOT NEEDED IF:
               • • Simple FS in well-appearing, immunized child
               • • No meningeal signs
               • • Source of fever identified
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                  Action

                  Acute Treatment

                  If seizure is ongoing

                  • ACTIVELY SEIZING:
                  • • ABCs, position safely
                  • • Benzodiazepine if >5 min (per SE protocol)
                  • POSTICTAL:
                  • • Supportive care
                  • • Treat fever (comfort, not to prevent recurrence)
                  • • Identify/treat source of fever
                  • Antipyretics do NOT prevent recurrence
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                     Outcome

                     Parent Counseling

                     Education and reassurance

                     • PROGNOSIS:
                     • • Benign condition
                     • • 30% recurrence risk (higher if young, low fever, family hx)
                     • • No increased risk of epilepsy with simple FS
                     • • No developmental or cognitive impairment
                     • RECURRENCE PREVENTION:
                     • • Continuous anticonvulsants NOT recommended
                     • • Intermittent diazepam NOT routinely recommended
                     • • Antipyretics do NOT prevent FS
                     • First aid instructions for any future seizure
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            Action

            Complex Febrile Seizure

            Requires more evaluation

            • CONSIDER:
            • • LP if meningeal signs or unimmunized
            • • EEG if focal features
            • • MRI if focal, prolonged, or neurologic concerns
            • Individualize workup based on:
            • • Duration and features
            • • Developmental status
            • • Physical exam findings
            • • Level of concern for CNS infection