Febrile Seizure in a Child: What to Do
A febrile seizure is a fit brought on by a fever, usually in children between 6 months and 6 years. Most last under 5 minutes and stop on their own. Stay calm, time it, keep your child safe, and do not put anything in their mouth. Call 995 (Singapore’s emergency number) if it lasts longer than 5 minutes or your child will not wake afterwards.
What to do during a seizure
Stay calm and work through these in order. The aim is to keep your child safe while the seizure runs its course. Most stop on their own within a few minutes.
Check the clock as soon as the seizure starts. Duration decides what happens next: at 5 minutes, call 995. Every minute will feel far longer than it is, so do not rely on your sense of time.
Guide your child carefully to the floor if they are on a raised surface. Move sharp objects and furniture away. Keep them away from stairs and water.
Loosen anything tight around the neck. Place a flat, soft object, such as a folded towel, under their head if one is nearby.
Roll them onto their side as soon as you can do it safely, so saliva or anything in the mouth can drain. You do not need to wait for the jerking to stop first.
No fingers, spoons, or medicine. They cannot swallow their tongue. Objects in the mouth can cause injury and block the airway.
Let the jerking run. Holding it down can injure joints. Do not slap, shake, or pour water on them to revive them.
Give nothing by mouth until they are fully awake and alert. They cannot swallow safely during or straight after a seizure.
Stay until their breathing returns to normal and they are awake. Talk calmly. When it stops, note how long it lasted and what it looked like, to tell the doctor.
When to call 995 or go to A&E
Call 995 now if your child has a fever and any of these:
- !A second seizure starts before your child has recovered from the first
- !This is the first seizure and you cannot get to a hospital quickly
- !A seizure lasting more than 5 minutes (give rectal diazepam if a doctor has prescribed it, and still call)
- !Struggling to breathe (skin pulling in under the ribs, nostrils flaring, or grunting), pauses in breathing, or lips turning blue or grey
- !Cannot be woken, or floppy and not responding to you
- !A rash of small red or purple spots that does not fade when you press a glass on it
- !Swelling of the lips, tongue, or face, with any difficulty breathing
- !Cold, clammy, or mottled skin, with drowsiness or restlessness
Go to the nearest 24-hour A&E or children's emergency now if:
- !Your child appears unwell after the seizure
- !The seizure affected only one side or one part of the body
- !Your child is under 6 months old
- !A baby under 3 months with a temperature of 38.0°C or above
- !A first febrile seizure, even if it has stopped
- !After a seizure: confused, still drowsy after 30 minutes, or more than one seizure in a day
- !A stiff neck, or crying in pain when bending the head forward
- !Unusually drowsy or hard to wake, but can be woken
- !Dengue warning signs as the fever comes down: tummy pain, repeated vomiting, bleeding gums or nose, or very tired
- !No urine or wet nappy for 12 hours or more
- !No tears when crying, sunken eyes, or a very dry mouth
- !Cannot keep any fluids down
- !Green vomit
- !A temperature above 40°C that is not coming down, and your child seems unwell
If the seizure lasts longer than 5 minutes, call 995. If your doctor has already prescribed rescue medication, such as rectal diazepam, for this child, give it as instructed, but giving it does not replace calling for the ambulance.
If the seizure was brief and has stopped, your child still needs to be seen. For a first febrile seizure, go to your nearest 24-hour Children's Emergency immediately, even though it has stopped. A doctor needs to confirm what it was and check the cause of the fever. If your child is still drowsy or confused 30 minutes after the seizure, go to the nearest 24-hour Children's Emergency. If they cannot be woken or are struggling to breathe, call 995.
If your child has had febrile seizures before, the fit was short and typical, and they are recovering normally, contact your doctor or polyclinic the same day for advice on whether to bring them in. Follow any specific plan your doctor has already given you.
After the seizure stops
When the jerking stops, most children go limp and appear deeply unresponsive. Breathing may sound shallow, slow, or irregular for a short period. This is the most frightening moment for bystanders and is often described as the child not breathing at all. It is part of the normal postictal phase. Keep them on their side and watch closely. Breathing should gradually settle and become more regular within a minute or two.
If breathing does not start to improve, or your child turns blue or grey, call 995 immediately. If breathing is settling, stay calm and let the postictal phase run its course.
After the initial limp phase, your child will likely remain drowsy, confused, or irritable. This can last from a few minutes to an hour. What to look for is gradual improvement: your child slowly becoming more alert over time. If they are not improving at all after 30 minutes, take them to the nearest 24-hour Children's Emergency.
- Keep them on their side and comfortable while they come round.
- Do not try to give food, drink, or medicine until they are fully awake and alert.
- Once awake, you can treat the fever for comfort with paracetamol by weight if needed.
- Note the duration and what you saw. This helps the doctor confirm it was a simple febrile seizure.
What a febrile seizure is
A febrile seizure is a convulsion triggered by a fever, most often between 6 months and 6 years of age. It can happen early in an illness, sometimes before you knew your child had a fever.
A typical febrile seizure moves through phases. The body usually stiffens first, eyes may roll back, and there may be frothing or drooling at the mouth. Then the arms and legs jerk rhythmically. The child is unresponsive throughout. When the jerking stops, the child typically goes limp and quiet, and breathing may sound shallow or irregular for a short time before gradually returning to normal. Not every seizure follows this pattern exactly: some children go straight to the limp phase, or the jerking may be subtle.
A simple febrile seizure lasts under 15 minutes, involves the whole body, and does not repeat within 24 hours. These are the common kind and do not cause lasting harm. Seizures that last longer, affect only one part of the body, or repeat in the same illness are less common and need closer assessment, which is one reason to get your child seen.
Two more things not to do
- Do not put your child in a bath or splash water on them to cool the fever. If another seizure happens in the water, it can block their breathing or cause drowning.
- Do not give medicine by mouth during the seizure or before they are fully awake and alert.
If it happens again
Around 1 in 3 children who have a febrile seizure will have another during a future fever. Giving fever medicine does not reliably prevent febrile seizures, so the goal of treating a fever stays the same: keeping your child comfortable, not preventing a fit.
If your child has a known tendency to febrile seizures, your doctor may give you a specific plan. Follow that plan. The steps for keeping your child safe during a seizure remain the same every time.
→ Fever with rash in a child: the blanch test and when to call 995
→ Toddler fever 39°C: when to monitor vs seek help
→ Fever at night: when should parents worry?
Frequently asked questions
What is a febrile seizure?+
A febrile seizure is a convulsion triggered by a fever in a child, most often between 6 months and 6 years of age. The body usually stiffens, then the arms and legs jerk rhythmically, and the child is unresponsive. When the jerking stops, the child typically goes limp and breathing may be shallow for a short time before gradually returning to normal. This limp, quiet phase is often the most alarming moment for bystanders. Most febrile seizures are brief and cause no lasting harm.
How long does a febrile seizure usually last?+
Most febrile seizures last less than 2 to 3 minutes and stop on their own. A simple febrile seizure lasts under 15 minutes and does not repeat within 24 hours. Time it if you can, because the duration affects what to do next.
When do I call 995 during a seizure?+
Call 995 if the seizure lasts longer than 5 minutes, if a second seizure starts before your child has recovered, if your child has trouble breathing or turns blue, or if they cannot be woken after the seizure stops. If you are ever unsure, call 995 and describe what you are seeing.
My child had a brief seizure and is now recovering. Do I still need to go to hospital?+
Yes, get them assessed. If this is the first febrile seizure, take your child to your nearest 24-hour Children's Emergency even though the seizure has stopped and they are coming round. A doctor needs to confirm it was a febrile seizure and check the cause of the fever.
Should I put something in my child's mouth during a seizure?+
No. Never put fingers, spoons, or anything else in the mouth of a child having a seizure. They will not swallow their tongue. Objects in the mouth can break teeth, block the airway, or injure you. Keep the area clear and turn them gently onto their side as soon as you can do it safely.
Will a febrile seizure cause brain damage or epilepsy?+
Simple febrile seizures do not cause brain damage and do not mean your child has epilepsy. Most children grow out of febrile seizures by around age 6. Around 1 in 3 children who have one will have another during a future fever, which is why knowing what to do makes a real difference.