Febrile Seizures in Babies

Febrile seizures are one of the most frightening experiences a parent can go through. Your child suddenly stiffens, their eyes roll back, their body begins jerking, and for a moment — which feels like an hour — you are certain something catastrophic is happening. Every parent who has been there will tell you the same thing: it felt like their child was dying.

They were not.

Febrile seizures are convulsions triggered by fever, and they affect 2 to 5 percent of children between the ages of 6 months and 5 years. They are the most common type of seizure in childhood, and despite how terrifying they look, the overwhelming medical consensus is that they are almost always benign — meaning they do not cause brain damage, they do not cause intellectual disability, and they do not mean your child has epilepsy.

Understanding what febrile seizures are, what they look like, and exactly what to do during one is the best preparation you can give yourself. Because if it happens, you will not have time to Google it.

David and Elena's 14-month-old daughter, Mia, had been fussy all afternoon with what seemed like a developing cold. She had a slight runny nose but no detected fever. Elena was giving Mia a bath before bed when she noticed Mia felt very warm. She took her out of the tub and was reaching for the thermometer when Mia suddenly went rigid in her arms.

Mia's whole body stiffened. Her eyes rolled upward. Then the jerking started — rhythmic, involuntary movements of her arms and legs. Elena screamed for David. He ran in and saw Mia's lips turning slightly bluish. Both parents were terrified.

David grabbed his phone. He remembered reading somewhere to time it. The seizure lasted about 90 seconds — though both parents would later say it felt like ten minutes. Then Mia went limp, her eyes closed, and her breathing became regular again. She looked like she had fallen into a deep sleep.

They called 911. By the time the paramedics arrived, Mia was waking up — groggy, confused, crying, but responsive. Her temperature was 103.4F. The paramedics took them to the ER, where the doctors confirmed it was a simple febrile seizure. Mia was back to her normal self within two hours.

Elena later said the worst part was not knowing what was happening. She had never heard of febrile seizures. If she had known what they were and what to do, those 90 seconds would still have been frightening — but they would not have been the single most terrifying moment of her life.

Febrile seizures are not caused by how high the fever gets. This is one of the most important things to understand, because it changes how you think about prevention.

Febrile seizures are triggered by the rapid rise in body temperature — the speed of the climb, not the peak. This is why they often occur at the very beginning of an illness, before a parent even realizes the child has a fever. The child's temperature may spike from normal to 102F within a short period, and that rapid change is what triggers the seizure in susceptible children.

This also explains why fever-reducing medications do not prevent febrile seizures. By the time you detect the fever and give a dose of acetaminophen or ibuprofen, the rapid rise has already happened. The medication will help with comfort, but it will not prevent a seizure. Multiple clinical studies have confirmed this.

Why some children have febrile seizures and others do not appears to be largely genetic. If a parent or sibling had febrile seizures, the risk is significantly higher. The developing brain between 6 months and 5 years of age appears to have a lower threshold for seizure activity in response to rapid temperature changes, and this threshold varies from child to child based on their genetic makeup.

The peak age for febrile seizures is between 12 and 18 months. They are rare before 6 months and uncommon after 5 years. Most children who are going to have febrile seizures will have their first one before age 3.

If your child has a seizure, your instinct will be to do something — to stop it, to hold your child, to fix it. The hardest part of managing a febrile seizure is accepting that there is nothing you can do to stop it. What you can do is keep your child safe while it runs its course. Here are the steps, in order:

Febrile seizures are classified into two types, and the distinction matters for follow-up care and long-term outlook.

Simple febrile seizures are the most common type, making up about 80 to 85 percent of all febrile seizures. They are generalized (affecting the whole body symmetrically), last less than 15 minutes (most are under 5 minutes), and occur only once within a 24-hour period. The child recovers fully within an hour or two. Simple febrile seizures carry an excellent prognosis — they do not cause brain damage and carry only a very slightly elevated risk of epilepsy compared to the general population.

Complex febrile seizures are less common (15 to 20 percent of febrile seizures) and have one or more of these features: they last longer than 15 minutes, they involve only one side of the body (focal), or they occur more than once within 24 hours. Complex febrile seizures still carry a good overall prognosis, but they typically warrant more thorough evaluation — your pediatrician may recommend an EEG (electroencephalogram) or, in some cases, imaging studies to rule out other causes.

The important thing to know is that even complex febrile seizures are, in most cases, a benign childhood phenomenon. The additional follow-up is precautionary, not because the outcome is expected to be bad.

After a febrile seizure ends, your child will enter what is called the postictal period. This is the recovery phase, and it can look almost as alarming as the seizure itself if you do not know what to expect.

Your child will likely be very sleepy — sometimes so deeply asleep that you have trouble waking them. This is normal. They may be confused, disoriented, or irritable when they do wake. Some children cry inconsolably for a while. Others just want to be held and drift in and out of sleep. This period typically lasts 15 minutes to an hour, sometimes longer.

During the postictal period, keep your child on their side, monitor their breathing, and let them rest. Do not try to force fluids immediately — wait until they are more alert. Once they are fully awake and responsive, you can offer breast milk, formula, or water.

Your child should be returning to their baseline behavior within one to two hours after a simple febrile seizure. If they are still very lethargic, confused, or not acting like themselves after two hours, call your pediatrician or go to the ER.

About one-third of children who have a febrile seizure will have at least one more. The recurrence rate is higher under certain circumstances.

Most recurrences happen within the first year after the initial seizure. If a child makes it two years without another febrile seizure, recurrence becomes less likely — though not impossible as long as they are in the susceptible age range (up to about 5 years old).

There is no medication that is routinely recommended to prevent febrile seizure recurrence. In the past, some doctors prescribed daily anti-seizure medication (particularly phenobarbital), but the side effects — including behavioral changes and cognitive effects — outweigh the benefits for a condition that is itself benign. The AAP does not recommend routine preventive medication for simple febrile seizures.

The best approach is preparation, not prevention. Know the signs. Know the steps. Have a plan. Tell your caregivers. And take comfort in the fact that even if your child has another febrile seizure, the overwhelming likelihood is that it will be just as harmless as the first one.

Every child who has a febrile seizure for the first time should be evaluated by their pediatrician, even if the seizure was brief and the child seems completely fine afterward. Your pediatrician will assess whether the seizure was simple or complex, look for the underlying cause of the fever, and discuss a plan for future episodes.

For a first-time simple febrile seizure, additional testing (EEG, imaging) is generally not needed. The AAP specifically recommends against routine EEGs or brain imaging for simple febrile seizures, as these tests rarely reveal anything actionable and can lead to unnecessary anxiety and further testing.

Additional evaluation is warranted if the seizure was complex (prolonged, focal, or repeated within 24 hours), if there are concerns about your child's development or neurological status, or if the cause of the fever is unclear and meningitis or encephalitis cannot be ruled out clinically. In these cases, your pediatrician may recommend blood tests, EEG, or imaging.

• When to Go to the ER for Baby Fever: Clear Guidelines by Age — the complete fever triage framework
• Infant Tylenol vs. Motrin: Dosing, Timing, and When to Use Each — fever reducer comparison and safety guide

• American Academy of Pediatrics (AAP). (2011). Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures. Pediatrics, 127(2), 389-394.
• Subcommittee on Febrile Seizures, AAP. (2011). Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure. Pediatrics, 127(2), 389-394.
• National Institute of Neurological Disorders and Stroke (NINDS). (2024). Febrile Seizures Fact Sheet. NINDS.NIH.gov.
• Verity, C. M., et al. (1998). Long-term Intellectual and Behavioral Outcomes of Children With Febrile Convulsions. New England Journal of Medicine, 338(24), 1723-1728.
• Offringa, M., & Newton, R. (2012). Prophylactic Drug Management for Febrile Seizures in Children. Cochrane Database of Systematic Reviews.
• Epilepsy Foundation. (2024). Febrile Seizures. EpilepsyFoundation.org.

This guide is for informational purposes only and is NOT a substitute for professional medical advice. When in doubt, always call your pediatrician. If your baby is under 3 months with a fever, having difficulty breathing, showing signs of dehydration, or seems seriously unwell, seek immediate medical attention.