Febrile convulsions guidance

Brief febrile convulsions need no specific treatment; cool the child by removing excess clothing and give antipyretic medication, e.g. paracetamol is commonly used to reduce fever and prevent further convulsions but evidence to support this practice is lacking. Ibuprofen may be given in between doses of paracetamol, if the temperature is not controlled adequately with paracetamol alone.

Prolonged febrile convulsions (those lasting 5 minutes or longer), recurrent convulsions, or those occurring in a child at known risk must be treated more actively, as there is the possibility of resulting brain damage. Diazepam or buccal midazolam may be given:

  • Diazepam: either by slow intravenous injection or preferably rectally in solution. The rectal route is preferred as satisfactory absorption is achieved within minutes and administration is much easier. Suppositories are not suitable because absorption is too slow.
  • Midazolam may be given as a single dose by the buccal route (intravenous solution for injection should be administered into the buccal cavity between the gum and cheeks using a syringe or straw), although it is not licensed for this indication

Intermittent prophylaxis (i.e. the anticonvulsant administered at the onset of fever) is possible in only a small proportion of children.

Long-term anticonvulsant prophylaxis for febrile convulsions is rarely indicated. Anticonvulsant treatment needs to be considered only for children at risk from prolonged or complex febrile convulsions, including those whose first seizure occurred at under 14 months or who have neurological abnormalities or who have had previous prolonged or focal convulsions.

 

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