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Health condition · Clinically reviewed

Febrile seizures, terrifying to watch, almost always benign.

The commonest seizure type in childhood. Most children have one episode and never another - what matters is knowing the first aid and when to worry.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CG160, NICE NG143 and specialist paediatric neurology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK paediatric practice including buccal midazolam first aid and community management of simple febrile seizures.

Key facts

Febrile seizures at a glance.

The essentials, in plain English - who gets them, what they look like, and what the outlook actually is.

  • What it is

    A seizure triggered by a rising temperature in an otherwise well child aged 6 months to 6 years, with no other cause of the seizure.

  • How common

    Around 2 to 5 per cent of children have at least one, making it the most common seizure type in childhood. Peak age 12 to 18 months.

  • Types

    Simple (roughly 70 to 75 per cent), complex (focal, prolonged or repeated within 24 hours) and febrile status epilepticus (over 30 minutes).

  • Family history

    A first-degree relative has had one in around 10 to 20 per cent of cases - genetic susceptibility is well recognised.

  • Outlook

    Simple febrile seizures are benign and do not cause brain damage. Recurrence in around 30 to 50 per cent - risk highest under 18 months.

  • Epilepsy risk

    Only a small minority go on to develop epilepsy (around 2 to 7 per cent versus 0.5 to 1 per cent in the general population).

Why this guide matters

Reassurance, first aid, and clear red flags.

Febrile seizures are common, benign and frightening. The three points below shape everything else on this page.

  • Simple febrile seizures are benign

    They do not cause brain damage. Around 70 to 75 per cent of episodes are simple - brief, generalised and once in 24 hours.

  • Rule out meningitis first

    The clinical priority is excluding meningitis and encephalitis, particularly under 12 months or when the picture is unclear.

  • Antipyretics do not prevent recurrence

    Use paracetamol or ibuprofen for comfort, not prevention. What prevents harm is knowing the first aid and when to call 999.

How the diagnosis is made

From the first seizure to a clear plan.

The steps a UK paediatrician or GP will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Duration, character, focal features, witness account and time of onset - the story often tells you whether it was simple or complex.

  2. 02

    Assessing

    Fever source examination

    Ears, throat, chest, abdomen and urine - a viral upper respiratory infection is the commonest driver.

  3. 03

    Assessing

    Meningism check

    Neck stiffness, Kernig and Brudzinski signs, fontanelle in infants - ruling out meningitis and encephalitis is the priority.

  4. 04

    Confirming

    Routine investigations, only if needed

    Bloods, cultures or urine dip are not routine per NICE and are guided by the clinical picture, not the seizure itself.

  5. 05

    Confirming

    Lumbar puncture when indicated

    Under 12 months, complex features, persistent neurology, immunocompromise or an unclear picture - to exclude meningitis.

  6. 06

    Specialist

    MRI and EEG in complex cases

    Reserved for complex, focal or prolonged seizures, febrile status, or when the history is atypical - via paediatric neurology.

  7. 07

    Specialist

    Specialist paediatric neurology

    Referral for febrile status epilepticus, recurrent complex episodes, focal features or diagnostic uncertainty.

Typical timeline: a first assessment in hospital, and a settled plan within hours to days.

Symptoms

What a febrile seizure looks like.

The classic pattern - and the features that turn a simple seizure into a complex one that needs a closer look.

  • Generalised tonic-clonic seizure

    Sudden stiffening followed by rhythmic jerking of all four limbs during a febrile illness - the classic simple picture.

  • Under six minutes, once in 24 hours

    Most simple febrile seizures are brief and self-limiting - by the time you reach hospital the child is often settling.

  • Post-ictal drowsiness

    A sleepy, floppy child for 10 to 30 minutes afterwards is expected - full recovery follows in most cases.

  • Focal features

    One-sided jerking, eye deviation or Todd’s paresis makes this a complex seizure - warrants specialist review.

  • Prolonged or clustered

    Over 15 minutes, or more than one seizure in 24 hours, meets the definition of complex febrile seizure.

  • Febrile status epilepticus

    A continuous or repeated seizure lasting over 30 minutes - a paediatric emergency needing immediate hospital care.

  • Terrifying to witness

    Parents often think their child is dying - reassurance and clear first aid advice make an enormous difference.

  • Red flag - meningism or altered consciousness

    A stiff neck, non-blanching rash, drowsiness that does not lift or a bulging fontanelle needs urgent assessment.

Treatment

How febrile seizures are managed in the UK.

First aid at home, rescue medication when needed, and specialist input for the small minority with complex or recurrent seizures.

  • First aid - stay calm

    Place the child on their side, protect from injury, do not restrain, do not put anything in the mouth and time the seizure.

  • Buccal midazolam (Buccolam)

    Rescue medication given by trained parents or clinicians if a seizure lasts more than 5 minutes - dosed by age and weight.

  • Rectal diazepam

    An alternative rescue option where buccal midazolam is not available - same 5-minute threshold.

  • Call 999

    If a seizure lasts over 5 minutes, repeats, or is the first ever seizure - or if the child is not recovering as expected.

  • Treat the underlying infection

    Viral illnesses need supportive care only; bacterial infections need targeted antibiotics after assessment.

  • Antipyretics for comfort

    Paracetamol or ibuprofen make a feverish child feel better but do not prevent another febrile seizure - use for comfort, not prevention.

  • Parent education pack

    Written advice, first aid steps, red flags and reassurance that this is benign and not epilepsy - the single most useful intervention.

  • Specialist paediatric neurology

    For complex, prolonged, recurrent or atypical episodes - and for families needing detailed EEG or MRI review.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or paediatrician knows your child and can tell you which parts apply. If in doubt after a seizure, get seen.

  • NICE CG160. Fever in under 5s: assessment and initial management.

  • NICE NG143. Fever in under 5s (updated). Includes guidance on febrile convulsions.

  • Royal College of Paediatrics and Child Health (RCPCH). Advice on febrile seizures for parents and clinicians.

  • BNF for Children. Buccal midazolam (Buccolam) and rectal diazepam dosing.

  • Epilepsy Society and Young Epilepsy. Patient information on febrile seizures and epilepsy risk.

Red flags

When a febrile seizure needs urgent attention.

Most febrile seizures are simple and settle quickly. These are the situations that aren’t - and where hospital assessment is needed.

  • Seizure lasting over 5 minutes

    Give rescue medication if trained and call 999 - prolonged seizures need urgent treatment to prevent status epilepticus.

  • Repeated seizures in 24 hours

    More than one episode within a day meets the complex febrile seizure criteria and warrants hospital assessment.

  • Focal features

    One-sided jerking, eye deviation or weakness afterwards points to a focal onset - needs specialist review.

  • Suspected meningitis

    Neck stiffness, bulging fontanelle, non-blanching rash, photophobia or persistent drowsiness needs urgent hospital care.

  • Age under 6 months or over 6 years

    Outside the classic age range the diagnosis becomes less likely - look harder for another cause of the seizure.

  • Not returning to baseline

    A child who is not waking properly, remains floppy or is behaving abnormally after the post-ictal period needs urgent review.

  • First febrile seizure

    The first episode always warrants a medical assessment - to confirm the diagnosis and rule out serious infection.

  • Immunocompromise or complex background

    Children with underlying conditions or immunosuppression need a lower threshold for admission and investigation.

  • Family history of epilepsy or Dravet

    SCN1A-related syndromes such as Dravet syndrome can present as prolonged or repeated febrile seizures - specialist review helps.

Living with it

A frightening event, with a reassuring outlook.

Four things that make the biggest difference in the days and weeks after a febrile seizure - reassurance, first aid, staying up to date on vaccinations, and knowing where to find support.

A quiet reminder

Terrifying to watch, almost always benign.

Most children who have a febrile seizure go on to have entirely normal childhoods, normal schooling and normal brain development.

  1. 01 Reassurance

    Benign, not epilepsy

    Simple febrile seizures do not cause brain damage and most children do not develop epilepsy - this is a passing feature of a developing brain.

  2. 02 Preparation

    Know the first aid

    Side-lying position, protect from injury, time the seizure, do not put anything in the mouth - call 999 after 5 minutes.

  3. 03 Vaccination

    Keep the schedule going

    Routine childhood immunisations are safe - post-vaccination febrile seizures are uncommon and the benefits far outweigh the risks.

  4. 04 Support

    You are not alone

    Young Epilepsy, the Epilepsy Society and Meningitis Now offer helplines and written advice for worried families.

Frequently asked

Everything parents ask about febrile seizures.

Quick answers on first aid, epilepsy risk, antipyretics and vaccinations.

  • What is a febrile seizure?

    A seizure triggered by a rising temperature in an otherwise well child aged 6 months to 6 years, with no other cause. Simple febrile seizures are generalised, last under 15 minutes, happen once in 24 hours and have no focal features. Around 2 to 5 per cent of children have at least one.

  • Will my child develop epilepsy?

    Almost certainly not. Only around 2 to 7 per cent of children with febrile seizures go on to develop epilepsy, compared with 0.5 to 1 per cent of the general population. The risk is higher after complex or prolonged seizures and with a strong family history, but even then the majority do not develop epilepsy.

  • Do antipyretics like paracetamol prevent another febrile seizure?

    No. Paracetamol and ibuprofen make a feverish child more comfortable but the evidence shows they do not prevent recurrence. Use them for comfort during a febrile illness rather than as a preventive strategy.

  • When should I call 999?

    Call 999 if the seizure lasts more than 5 minutes, if the child has repeated seizures without recovering in between, if this is a first ever seizure, if the child is not breathing normally, or if you are worried about meningitis - a non-blanching rash, stiff neck, bulging fontanelle or persistent drowsiness.

  • What is buccal midazolam?

    Buccal midazolam (brand name Buccolam) is a rescue medication squirted between the cheek and gum to stop a prolonged seizure. Parents of children at risk of prolonged seizures may be trained to give it if a seizure lasts more than 5 minutes. Rectal diazepam is an alternative where midazolam is not available.

  • Can my child still have their vaccinations?

    Yes. The routine UK childhood immunisation schedule is safe and recommended, including after a febrile seizure. Post-immunisation febrile seizures are uncommon and are the same benign event as any other febrile seizure. The MMR vaccination given around 12 to 14 months coincides with the peak age for febrile seizures, which is why they can occur close together by chance.

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