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TL;DR - Treat the parent. Screen for red flags. Screen for complicating factors. Education. Handout. Home, unless requiring investigation for complicating factors (ie. Complex febrile seizure)

This article is deliberately written in the negative for easy copy/pasting. Common sense required for interpretation.

Step 1: Treat the parent (they are likely freaking out)
“Kids can get a very high fever quickly that causes a seizure”
“Usually from a simple viral infection”
“Almost always not harmful (benign).”
“Reducing temperature of room or giving panadol does not reduce risk of further seizures”
“3% of kids get them, and they can recur.”
“1 in 3 will have further febrile seizures”
“Tend to grow out of it by 6yo”
“Sometimes patients can have complex febrile seizures, but even then there is low risk of brain damage”
“Risk of epilepsy is about 1%, which is similar to background risk”

Step 2: Complete History
Baseline History:
Timing / Seizure Details:
Prodromal symptoms: coryza and fever
There is no history of trauma
Development history is unremarkable. IUTD. Otherwise well child grossly meeting development milestones.

Step 3: Rule out red flags: Notify senior doctor if any flags positive.
Child is not very young (< 6mo) (risk CNS infection)
No history of afebrile seizures
No developmental delay
No clinical meningism: photophobia. Kernig’s and Brudzinski’s.

Step 4: Confirm It Really Is a Simple Febrile Seizure
Patient is at an age in which febrile seizures commonly occur (between 6mo and 6yo)
Objectively Febrile, with measured temperature of: ___
Witnessed generalised, tonic clonic
Seizure lasted for only about ___ minutes. (Well under 15 minutes)
There has been complete recovery within 1 hour
There has been no other episodes during this illness (No recurrence within the same febrile illness.)
There are no focal features reported (or witnessed) at the onset or duration of the seizure.
No history of trauma
^ If any of the criteria above are not met, then it is a complex seizure. Refer to paeds for admission.
* (note if pt seizes in department give Midaz after 5 min as usual per seizure protocol)

If there are any red flags, escalate to a senior doctor quickly. If there are any complicating factors (not a simple febrile seizure), admit paeds and initiate investigations. 

Complex (non-simple) febrile seizure:
– Pathology: BSL, FWT UMCS, FBE CRP, U&Es
– Discuss with paediatrics team regarding indications for LP
– Educate mother: Needs observation and investigation + handout.