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Clinicians who evaluate infants or young children after a simple febrile seizure should "direct their attention toward identifying the cause of the child's fever."
Df: Febrile seizure occurs in 2% to 5% of all children ages 6 to 60 months. It is characterized by a fever, or a body temperature of at least 100.4°F or 38°C, taken by any method, in children with no central nervous system infection. Complex febrile seizure is focal (affecting only specific parts of the body), lasts 15 minutes or longer, and/or recurs within 24 hours.Simple febrile seizure is generalized, lasts for less than 15 minutes, and does not return within 24 hours. In 1980, the National Institutes of Health designated simple febrile seizure as a benign event, with excellent patient prognosis.
Meningitis should be considered in the differential diagnosis for any febrile child, and lumbar puncture should be performed if there are clinical signs or symptoms of concern. For any infant between 6 and 12 months of age who presents with a seizure and fever, a lumbar puncture is an option when the child is considered deficient in Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae immunizations (ie, has not received scheduled immunizations as recommended), or when immunization status cannot be determined, because of an increased risk of bacterial meningitis. A lumbar puncture is an option for children who are pretreated with antibiotics. In general, a simple febrile seizure does not usually require further evaluation, specifically electroencephalography, blood studies, or neuroimaging.
Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure (Subcommittee on Febrile Seizures) Pediatrics February 2011;127(2):389-394 (doi:10.1542/peds.2010-3318). Published online February 1, 2011
AAP investigators examined evidence-based literature from 1996-Feb. 2009 pertaining to children presenting with simple febrile seizure. They suggested the following key action statements:
- Children with meningeal signs, or young patients with a suggestion or history of meningitis or intracranial infection, should undergo lumbar puncture, without exception.
- Any infant between the ages of 6 and 12 months should have lumbar puncture as an option whenHaemophilus influenzae type b or Streptococcus pneumoniae immunizations are not current, or are not known.
- A child who has been pretreated with antibiotics should have lumbar puncture as an option because antibiotics can mask meningitis.
- In neurologically healthy children, an electroencephalogram (EEG) should never be performed.
- In the quest to identify simple febrile seizure cause, diagnosticians should not perform the following tests: serum electrolytes, calcium, phosphorus, magnesium, or blood glucose measurements; or complete blood cell count.
- Routine evaluation of children with simple febrile seizure should not include neuroimaging
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