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Febrile Seizure Guide: Recognize, Respond, Prevent

  • Writer: Natalie Wescott
    Natalie Wescott
  • Aug 11
  • 13 min read
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A febrile seizure is a convulsion that occurs in young children, most often between 6 months and 5 years old, in response to a sudden and rapid rise in body temperature. This usually happens during common viral illnesses like a cold, ear infection, or the flu. While they can be incredibly frightening to witness, febrile seizures are relatively common, affecting about 4% of children. Knowing what they are, how to respond in the moment, and ways to help prevent them can make a big difference. This guide is here to help you feel more equipped and confident in handling what can otherwise feel like a very scary situation.


This guide and associated Instagram post was a collab with Alex, a naturally-minded mom from @thenaturalmindedmama


First, what is a Fever?

The hypothalamus, a small region at the base of the brain, serves as the body’s internal thermostat. It continuously monitors and regulates core body temperature by responding to signals from both internal organs and external temperature receptors in the skin. Under normal conditions, the hypothalamus maintains a steady body temperature through a balance of heat production and heat loss, allowing temperature changes to occur gradually. 

However, during an illness, particularly infections, the body produces pyrogens, which are substances that signal the hypothalamus to raise the body’s temperature set point. This is a deliberate defense mechanism designed to create an environment that pathogens cannot thrive in. In response, the body begins generating and conserving more heat, leading to a fever.

A fever is a GOOD THING. It indicates that the immune system is working effectively to fight illness and infection.

Here is my full fever guide! Fever Guide: Home Remedies or ER?


What Causes a Febrile Seizure?

There is some debate within the medical field as to what causes a febrile seizure: a rapid rise in temperature or the high temperature itself. The AAP along with other medical sources claim that it is the number on the thermometer that causes the seizure (a high fever), but state that the fever can be as low as 100.4F. Oftentimes, in practice, it is a rapid change in temperature that seems to trigger a febrile seizure. 

In most fevers, the increase in temperature happens gradually, giving the brain and body time to adjust. But in some children, particularly those between 6 months and 5 years, the body’s temperature may spike rapidly over a short period of time. In these cases, it is believed that the sudden surge can overwhelm the nervous system and trigger a febrile seizure.

Many times, febrile seizures are the first sign of illness, because the seizure happens before the child even has a noticeable fever or other symptoms (1-3). This falls in line with the belief that febrile seizures are triggered by a rapid rise in temperature. 

As an ER nurse, I have seen parents rush their child to the ER for seizure activity. At arrival, the parent will often deny any recent illness, but they will have a fever on assessment. The fever is not always super high, sometimes it will be less than 102F. This happens quite frequently, leading me to believe that it is a rapid rise in temperature that is the main culprit. I have also seen seizures occur when parents put a fevering child in a cold bath. This causes the body temperature to rapidly drop, and the child seizes. This is an important reason why children should not be given cold baths when fevering. They should be only placed in warm water that cools as they sit there. 


Febrile Seizures:

  • are most common in children between 6 months and 5 years old

  • typically last a few seconds to a few minutes

  • happen in about 2-5% of children

  • are not caused by epilepsy and do not lead to an epilepsy diagnosis

  • usually don’t lead to long-term health problems


What Does a Febrile Seizure Look Like?

During a febrile seizure, your child may:

  • Stiffen and shake or twitch

  • Roll their eyes back

  • Lose consciousness

  • Often will pee or poop themselves 

  • Be sleepy or confused afterward for at least 30 mins

Here is a 3D animation of what a febrile seizure may look like.

It can be incredibly unsettling to witness, but most febrile seizures are harmless and will stop on their own.


Types of Febrile Seizures

Simple Febrile Seizures: These seizures happen more often and involve the whole body. They usually last under 15 minutes and only happen once within 24 hours. 

  • 70-80% of all febrile seizures

  • Most simple febrile seizures only last a few seconds to a few minutes. 

Complex Febrile Seizures: These seizures can last longer than 15 minutes, happen multiple times in one day, or affect only one specific part of the body instead of the whole body.

  • Uncommon, and can sometimes lead to an epilepsy diagnosis

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What Should You Do During Seizure?

  1. Carefully lay the child down on the floor or ground and turn them on their side to prevent choking.

  2. Remove any nearby objects that could cause injury.

  3. Ensure clothing around the head and neck is loose, not tight

  4. Look at the time so you know how long the seizure lasts (a minute can feel like an eternity, but you want to know an accurate timeline)

  5. Call 911 if this is your child’s first seizure. They usually do not need intervention if the seizure lasts less than 5 minutes, but by chance it were to last longer, you want EMS to already be on their way. 

    • If your child is prone to febrile seizures and you as a parent are confident in accurate timing and care, calling 911 right away may not be necessary. 

    • If the child is having difficulty breathing (gasping, or not breathing at all) or is turning blue in the face, call 911. 

  6. If the seizure ends within five minutes, call your trusted provider afterward for advice.

  7. After a seizure, your child will be drowsy and "out of it" for about 30 minutes. This is called the postictal period and is normal. Do not try to keep them awake or overstimulate.


What Should You NOT Do?

  1. Do not put anything in the child’s mouth.

  2. Do not hold down or restrain the child.

  3. Do not try to cool the child with cold water or give fever-reducing medicine during the seizure.


When to Call 911?

  • The child is experiencing their very first febrile seizure.

  • The child is under 3 months old or over 6 years old.

  • The seizure continues for more than 5 minutes.

  • The child has trouble breathing during or after the seizure.

  • The seizure affects only specific areas of the body rather than the whole body.



Risk of Re-Occurrence

Recurrence Risk After a First Febrile Seizure

  • About 30% of children who have one febrile seizure will go on to have at least one more.

  • If the first seizure occurs before 18 months of age, the risk of recurrence increases to around 50%.

  • Most recurrences happen within 1 to 2 years of the first episode.

If your child has a febrile seizure, consider having them tested for deficiencies (more on this later) to potentially help prevent recurring seizures 


Factors That Increase Risk of Recurrence:

  1. Young age at first seizure

    • Children under 18 months have a higher likelihood of recurrence.

  2. Family history of febrile seizures

    • If a parent or sibling had them, the child is at greater risk.

  3. Low-grade fever during first seizure

    • If the first seizure happened at a relatively low fever (e.g., 100.4–101°F), the threshold is likely lower, which may make future seizures more likely.

  4. Short interval between fever onset and seizure

    • If the seizure occurred soon after the fever began, it suggests a lower seizure threshold to rapid rises in temperature.

  5. Potential uncorrected vitamin and mineral deficiencies 

If your child has had multiple febrile seizures, you may be referred to a pediatric neurologist or given medications to help stop seizures once they start. The good news is, the majority of children grow out of having febrile seizures by age 5. 


Do Fever Suppressants Prevent Febrile Seizures? 

Despite the debate of causation, it is widely agreed that Tylenol does NOT prevent febrile seizures (4-8). While Tylenol (acetaminophen) helps reduce fever and discomfort, it doesn’t change the brain’s seizure threshold or how it reacts to rising temperature. Additionally, febrile seizures often happen early during the fever’s onset, before medication can take effect and/or before a parent even knows there is an illness. 

Several studies, including a large Cochrane review of three clinical trials, found no significant difference in seizure risk between children who were given fever-reducing medications and those who weren’t (9). Another study specifically looking at ibuprofen showed no reduction in seizure recurrence compared to placebo (10). Even rectal acetaminophen, often thought to work faster, did not prevent febrile seizures from recurring during later illnesses (11).

The American Academy of Pediatrics clinical practice guideline on simple febrile seizures also explicitly states that while antipyretics like acetaminophen or ibuprofen may improve comfort, they do not reduce the recurrence of febrile seizures. No evidence supports their use solely for seizure prevention (12). 


Why You Should Avoid Fever Suppressants

A fever is a natural response to an infection or illness. It is a good sign, because it means that your body is fighting off the infection. The increased body temperature from a fever boosts the performance of immune cells and induces stress on pathogens and infected cells, providing a strong immune defense.

Since fevers are the body’s natural way of fighting off illnesses, reducing a fever can actually prolong the illness or infection. Fevers also trigger immune cells to recruit and activate T-cells, which coordinate long-term “adaptive” immune responses such as antibody production. By letting a fever run its course, you are also providing better protection for future illnesses.

How High is Too High? The "Dreaded" 104°F

Parents are told that fevers over 104°F need to go to the ER, but that is not always the case. If the child is relatively comfortable with a temperature of 104°F, you can continue to support their healing at home.

104°F will not “fry” your child’s brain

It is not uncommon for a child's temperature to reach up to 104°F, and the hypothalamus typically prevents the temperature from going any higher. While each person's body is different, a fever up to 106°F is usually harmless. It is not until 108°F that brain damage is possible (13-16), and this typically only happens if the air temperature is very high, such as being locked in a closed car during the summer (16).

See my fever guide for more information: Fever Guide: Home Remedies or ER?


When Should You Consider a Suppressant? 

Ibuprofen (Motrin) or Acetaminophen (Tylenol)?

Acetaminophen (Tylenol) lowers glutathione stores - an antioxidant very important in immune function. By lowering this antioxidant, we are prolonging the illness, compromising detoxification, increasing inflammation and oxidative stress, and increasing the risk of damage to vital organs. 

Ibuprofen (Motrin) does lower glutathione, but not to the extent that acetaminophen (Tylenol) does.

The other problem with fever suppressants is that they stop the body's natural immune response. A fever actively kills pathogens and helps the body to recover. When we lower a fever, the pathogens are allowed to thrive for longer which prolongs illness. 

The only time that I would reduce a fever is when the child is unable to drink or sleep. Hydration and restorative sleep are two of the most important aspects of healing. If choosing to reduce a fever, opt for natural options first (such as a lukewarm bath, peppermint oil, wet sock trick). If those are unsuccessful, you can try reducing the fever with medicine. Try ibuprofen first (in children over 6 months old). In my ER experience, ibuprofen is more effective than tylenol for most children in lowering fevers and reducing discomfort. 


So, What CAN You Do to Prevent Febrile Seizure? 

First, we have to ask an important question- why isn’t the child’s nervous system able to handle this natural response in the body? Yes, it’s true that a young child’s brain is still developing, and the systems that regulate electrical activity aren’t fully mature, which can make their brains more excitable. But as a mom, I’m not comfortable settling for the idea that “some kids just get febrile seizures and there’s nothing you can do,” especially when fever suppressants don’t consistently prevent them.

Is there anything I can do to support my child and be proactive? Thankfully, the answer is yes.

Iron Deficiency & Febrile Seizures 

Iron deficiency anemia has been consistently linked to an increased risk of febrile seizures in children. Iron plays a vital role in brain metabolism, neurotransmitter synthesis, and oxygen transport - processes crucial for normal neurological function.

A systematic review and meta-analysis of 20 studies found that children with febrile seizures had significantly lower iron levels compared to controls (17). Another case-control study reported that 65.7% of children with febrile seizures were iron deficient, compared to only 45% of febrile children without seizures (18). These findings suggest that iron deficiency may lower the seizure threshold during febrile illnesses.

Zinc Deficiency & Febrile Seizures 

Zinc is essential for regulating neurotransmitter activity, brain development, and immune function. Several studies have found significantly lower serum zinc levels in children who experience febrile seizures compared to those with fever but no seizures.

One study noted lower zinc and iron levels as possible risk factors for febrile seizures (19). However, findings are not universally consistent. A study in Navi Mumbai found no significant difference in zinc levels between children with febrile seizures and controls (p = 0.733), suggesting other factors may also play a role (20).

While the evidence is mixed, zinc deficiency may still contribute to seizure susceptibility by altering neuronal excitability.

Vitamin D Deficiency & Febrile Seizures 

Emerging research suggests a link between vitamin D deficiency and febrile seizures. Vitamin D plays a role in brain development, calcium balance, and immune regulation. 

In a study conducted in Karnataka, India, 71% of children with febrile seizures had insufficient vitamin D levels, and 13% were severely deficient (21). Another study found significantly lower 25-hydroxyvitamin D levels in children with febrile seizures, along with reduced levels of iron, calcium, and zinc (22).

Although more research is needed, these findings suggest that low vitamin D may increase seizure susceptibility during febrile illness.

Magnesium Deficiency & Febrile Seizures

Magnesium plays a vital role in neurological function by modulating the activity of N-methyl-D-aspartate (NMDA) receptors in the brain, which influence excitatory neurotransmission.

Low magnesium levels may enhance neuronal excitability and increase susceptibility to seizures. Although evidence is limited, some case reports and smaller studies have observed an association between hypomagnesemia and seizure occurrence, including febrile seizures. Supplementation in deficient children might help reduce seizure frequency (23-25).

Calcium Deficiency & Febrile Seizures

Calcium is essential for neurotransmitter release and proper synaptic function. Hypocalcemia (low calcium levels) can disrupt normal neuronal signaling, potentially facilitating seizures. Some investigations have identified transient hypocalcemia during febrile illnesses in children who experienced seizures, indicating a possible role (26-27).

Vitamin B6 & Febrile Seizures

Vitamin B6 is crucial for the synthesis of neurotransmitters such as gamma-aminobutyric acid (GABA), the brain’s primary inhibitory neurotransmitter. 

Deficiency in vitamin B6 can lead to decreased GABA production, reducing inhibitory control in the nervous system and potentially lowering the seizure threshold.

Although classic pyridoxine (a form of B6) dependent epilepsy is rare, milder B6 deficiency has been suggested as a contributing factor in some cases of febrile seizures. Supplementation with pyridoxine has shown benefit in reducing seizures in select patients (28). 

Melatonin and Febrile Seizures

Melatonin has been explored as a potential option to help prevent febrile seizures in children. If you’re considering melatonin supplements for your child, it’s important to consult with your doctor beforehand. The amounts used in studies tend to be higher than typical doses and may carry risks of side effects, so medical supervision is necessary (29-30). 

Selenium and Febrile Seizures

Some studies suggest that low selenium levels may be linked to an increased risk of febrile seizures in children, possibly due to selenium’s role in protecting the brain from oxidative stress during fever (31-32).

Children experiencing febrile seizures have been found to have lower serum selenium compared to healthy peers. However, the research is still limited and more extensive studies are needed to confirm whether selenium deficiency contributes to febrile seizures or if supplementation could be beneficial.

The Importance of Electrolytes

Electrolyte disturbances, particularly hyponatremia (low sodium levels in the blood), have been implicated as a potential trigger that lowers the seizure threshold during febrile illnesses.

Sodium is critical for proper nerve function and maintaining the electrical stability of neurons. When sodium levels drop, neurons become more excitable, increasing the risk of seizures during a fever.

Several clinical studies have reported that children experiencing febrile seizures sometimes show mild hyponatremia during their illness, suggesting that maintaining electrolyte balance could be important in managing seizure risk (33-35).

**We share these links between nutrient deficiencies and febrile seizures for your awareness, but as mentioned, there isn’t enough evidence to confidently say that increasing these nutrient levels will lower the risk of febrile seizures.

Test, Don’t Stress

If you are ensuring your child is living a healthy lifestyle by eating well, getting in daily sunshine and movement, supporting their immune system, hydrating, breathing properly (no mouth breathing!!), and getting adequate REM cycle sleep, then their risk of deficiencies and febrile seizures is going to be relatively low. 

However, if the thought of febrile seizures and the possibility of a nutrient deficiency is an area of stress for you - test don’t stress!

Most pediatricians can easily test for these deficiencies in office, especially iron, vitamin D, zinc, and magnesium. 

Support the Immune System 

Since most febrile seizures are triggered by viral illnesses, reducing the frequency and severity of infections is the best first-line approach. Click here for an in-depth immune support guide!


In Conclusion

Febrile seizures can be incredibly scary in the moment, but remember, you’re not powerless. Understanding what they are, why they happen, and how to respond calmly can make all the difference. This guide isn’t meant to instill fear, but to equip you with knowledge, confidence, and peace of mind. As a mom, your instincts are powerful, and when paired with preparation and education, you’re fully capable of supporting your child through illness safely and naturally. You don’t have to fear fevers, you just need to be informed, supported, and ready.



Sources:

9-11 Offringa, M., Newton, R., & Nevitt, S. (2013). Antipyretic drugs for preventing febrile seizures. Cochrane Database of Systematic Reviews2 Strengell, T. et al. (1999). Antipyretic agents and febrile seizures: randomized trial. PubMed ID: 97949813 Murata, S. et al. (1994). Rectal acetaminophen and febrile seizure recurrence. PubMed ID: 7776115

13 Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine, 7th Edition (Lippincott Williams & Wilkins, 2016)

14 Nelson Textbook of Pediatrics, 21st Edition (Elsevier, 2019)

17 Kumari et al., 2020, AAP Grand Rounds

18 Sharma et al., 2020, PJSR

31 Amiri, M., Farzin, L., Moassesi, M.E. et al. Serum Trace Element Levels in Febrile Convulsion. Biol Trace Elem Res 135, 38–44 (2010). https://doi.org/10.1007/s12011-009-8487-6

7 Sood et al. (2019) in JMSCR https://dx.doi.org/10.18535/jmscr/v7i2.48



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