Pediatric Febrile Seizure
Seizure with fever in child 6-60 months
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Pediatric Febrile Seizure (AAP 2011)
Pediatric Febrile Seizure (AAP 2011): Pediatric Febrile Seizure → Definition & Classification → Simple or Complex? → Simple Febrile Seizure → When to Co...
Pathway Overview
8 steps
Algorithm Steps
8 total
01Start 02Action 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
03Decision Simple or Complex?
Classify the febrile seizure
04Action 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
05Warning 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
06Action 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
07Outcome 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
08Action 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
- Path rejoins step 05Shared downstream outcome
Guideline Source
AAP Clinical Practice Guideline: Neurodiagnostic Evaluation of Simple Febrile Seizure 2011
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Ages 6-60 months
- Does not cover afebrile seizures
- Complex FS needs individualized workup
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Febrile Seizure (AAP 2011)?
The Pediatric Febrile Seizure (AAP 2011) is a management clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AAP Clinical Practice Guideline: Neurodiagnostic Evaluation of Simple Febrile Seizure 2011.
What guideline is the Pediatric Febrile Seizure (AAP 2011) based on?
This algorithm is based on AAP Clinical Practice Guideline: Neurodiagnostic Evaluation of Simple Febrile Seizure 2011 (DOI: 10.1542/peds.2010-3318).
What are the limitations of the Pediatric Febrile Seizure (AAP 2011)?
Known limitations include: Ages 6-60 months; Does not cover afebrile seizures; Complex FS needs individualized workup. Individual patient factors may require deviation from these recommendations.
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