Pediatric Febrile Seizure — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Still seizing now?
   Is the child still seizing now? (Febrile seizure = age 6–60 months, fever (≥38°C) with a seizure, without CNS infection or a defined metabolic cause. Protect the airway, lateral position, do not restrain forcibly, record start/stop times.)
   • Still seizing → Ongoing seizure → terminate
   • Stopped (postictal) → Classify
2. [End] Ongoing seizure → terminate
   Seizure >5 min: manage as status epilepticus — benzodiazepine (IV lorazepam/midazolam; if no IV, IM/intranasal/rectal midazolam or diazepam); oxygen, monitoring, check glucose; concurrently treat fever and find the cause of the fever.
3. [Decision] Classify
   Simple or complex? (Simple: generalized, <15 min, only once in 24 h, prior normal neurodevelopment. Complex: focal, ≥15 min, or recurring within 24 h.)
   • Simple → Simple (benign)
   • Complex → Complex
4. [End] Simple (benign)
   Simple febrile seizure (benign, self-limited): usually no LP/EEG/neuroimaging/routine bloods needed — focus on finding and treating the cause of the fever. LP only if meningitis is suspected (meningismus, ill-appearing, rash) or at 6–12 months with incomplete/unknown Hib/pneumococcal vaccination. Antipyretics are for comfort, not to prevent recurrence; educate parents on the benign nature, recurrence risk and when to seek care.
5. [End] Complex
   Complex: individualized evaluation — decide on LP by clinical suspicion (suspected CNS infection), neuroimaging (focal signs, persistently abnormal consciousness, suspected mass), EEG; observe closely, alert to underlying neurological pathology. Age <12 months, focal or recurrent cases warrant more careful work-up.

Source guidelines & references

• AAP clinical guideline: neurodiagnostic evaluation of the simple febrile seizure. Pediatrics 2011;127:389 · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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