GPAtlas🧭 When to suspect
A febrile seizure (febrile convulsion) is a seizure accompanied by fever (temperature ≥ 38°C) in a child, occurring in the absence of infection of the central nervous system (CNS), metabolic disturbance, or a history of afebrile seizures. They are the commonest seizure type in childhood, affecting around 2–5% of children, with a peak at about 18 months. They occur between 6 months and 5 years of age and are uncommon under 6 months or after 6 years.
The clinical task in primary care is threefold: confirm it is a simple febrile seizure, find and treat the source of the fever while excluding serious infection (especially meningitis), and reassure the family. Most are benign and self-limiting; the skill is recognising the minority that are not. The classification below – from the National Institute for Health and Care Excellence (NICE) – drives that decision.
| Feature | Simple febrile seizure | Complex febrile seizure |
|---|---|---|
| Seizure type | Generalised (both sides) | Focal onset (one limb or one side) |
| Duration | Less than 15 minutes | More than 15 minutes (> 30 min = febrile status epilepticus) |
| Recurrence in 24h / same illness | None | Recurs within 24 hours or the same febrile illness |
| Recovery | Complete within 1 hour | Incomplete within 1 hour |
A seizure is complex if it has any one of the features in the right-hand column; otherwise it is simple. Around two-thirds of febrile seizures are simple.
Source: NICE NG143 · NICE NG217
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