# Simple Febrile Seizure - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAP Clinical Practice Guideline: Febrile Seizures 2011 · Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12) · Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure-simple-full.txt) - Verified date: 2026-08 ## Verified against - AAP Clinical Practice Guideline: Febrile Seizures 2011 - Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12) - No dose - referral pathway, no medicine given in primary care - Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure-simple-full.txt) ## Treatment metadata - Paracetamol — 120 mg — oral.liquid - Referral & safety-netting (no drug therapy) - Diazepam — 5 mg — injection ## Complete treatment card ```text SIMPLE FEBRILE SEIZURE Sources: AAP Clinical Practice Guideline: Febrile Seizures 2011 · Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12) · Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure- simple-full.txt) Review status: REVIEWED against AAP Clinical Practice Guideline: Febrile Seizures 2011, Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12), No dose - referral pathway, no medicine given in primary care, Febrile Seizure - StatPearls - NCBI Bookshelf - disease-level clinical article (febrile-seizure-simple- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - One generalised tonic-clonic episode under 15 minutes, then a short spell of drowsiness [drowsiness] - The complex type instead: focal, one-sided, 15 minutes or longer, or repeating inside 24 hours - One-sided weakness or paralysis afterwards (Todd paralysis) marks the complex type [one-sided weakness · paralysis] - Either type may involve loss of consciousness, frothing, breathlessness and blue discolouration [breathlessness · cyanosis · loss of consciousness] - It is a generalised seizure in a child between 6 months and 5 years of age, with a fever above 38 °C [fever · seizures] - The diagnosis needs CNS infection, an electrolyte upset, low blood sugar, substance use and any earlier seizure without fever excluded first [hypoglycaemia · seizures] - There is no threshold temperature that sets one off, because the convulsive threshold differs from child to child - Red flag: past 30 minutes it is febrile status epilepticus, a rare subset that does worse than the simple kind [fever · status epilepticus] - Risk factors are existing neurological impairment, developmental delay, a family history of seizure, viral infection, low serum zinc and iron, and maternal smoking and stress [developmental delay · seizures] SIGNS - what you find (6) - The child must be back to their own neurological baseline afterwards - Lingering headache, muddled thinking or weakness moves the diagnosis elsewhere [confusion · headache] - Hunt the fever source: red bulging drums, red pharynx, big inflamed tonsils, neck stiffness, tense fontanelle, Brudzinski sign [bulging fontanelle · fever · neck rigidity on testing · neck stiffness] - Include fundoscopy to look for raised intracranial pressure - A one-sided port-wine stain on the skin is a meaningful clue - Pale depigmented patches suggest tuberous sclerosis [pallor] TESTS (7) - A textbook simple febrile seizure needs no further investigation - A complex seizure earns a full work-up for structural or infectious causes, plus an EEG - Blood count, metabolic panel and urinalysis only where there is dehydration, poor intake, vomiting or diarrhoea - Lumbar puncture is unnecessary once the child is quickly back to baseline, but do it where CNS infection is a concern - Consider lumbar puncture under 12 months, if pneumococcal or Hib cover is incomplete, if the fit came 2 days after the fever began, or on antibiotics that could mask meningitis - Head CT or MRI is not routine after a febrile seizure - Image when there is raised intracranial pressure, a focal deficit, a suspected brain malformation, an enlarged head or serious head injury IF NOT THIS - what else fits (10) - Breath-holding spells - CNS infection: meningitis or encephalitis - Drug-induced seizure - Febrile delirium - Febrile myoclonus - Febrile infection-related epilepsy syndrome (FIRES) - Genetic epilepsy with febrile seizures plus (GEFS+) - Metabolic upset such as low sodium - Shaking chills or rigors - Tonic-clonic seizure not driven by fever Score WHO Emergency Triage (sick child) - Is this sick child safe to wait? Source StatPearls "Febrile Seizure" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult Not applicable - pediatric entry x 2-3 days during febrile illness Peds 15 mg/kg/dose [child max 500 mg] (Give 15 mg/kg every 4-6 hours as needed (or rectal suppository if vomiting); max 60 mg/kg/day) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source AAP Clinical Practice Guideline: Febrile Seizures 2011 Why Antipyretic and analgesic given for the child's comfort during the febrile illness; it does not prevent febrile seizure recurrence and is not given to treat the seizure itself. Caution CRITICAL COUNSELING: Antipyretics improve child comfort but DO NOT prevent febrile seizure recurrence per AAP 2011 guidelines. A simple febrile seizure is defined as generalized tonic-clonic, <15 minutes duration, non-recurrent within 24 hours in a neurologically normal child aged 6-60 months. Reassure parents: simple febrile seizures carry no increased risk of brain damage or mortality. Antipyretics relieve fever distress but do NOT reduce the risk of febrile seizure recurrence. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML MEMPHIS 8.50 EGP PARAGESIC BABY 120MG/5ML 120ML SUSP. AMRIYA 36.00 EGP PARAMOL 120MG/5ML SYRUP 125ML MISR 36.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral liquid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral liquid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source No dose - referral pathway, no medicine given in primary care Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The lumbar puncture criteria to rule out meningitis or CNS infection after a febrile seizure are age under 12 months, inadequate Strep pneumoniae/Hib immunization, seizure occurring 2 days after fever onset, or current antibiotic use that may mask meningitis. RED FLAG - Counsel that antipyretics (including paracetamol) do not prevent febrile seizure recurrence, so their use should not be framed as seizure prevention. Manage the fever with paracetamol, not aspirin. A child who has not returned to their neurological baseline - persisting headache, cognitive change or weakness on examination - should prompt a search for a diagnosis other than a febrile seizure. A complex febrile seizure needs a full evaluation to rule out structural and infectious causes, including an EEG. Omitting lumbar puncture is only safe when the seizure was simple and the child has returned rapidly to baseline. Head imaging after a febrile seizure is warranted only for raised intracranial pressure, a focal neurological abnormality, a suspected structural brain defect, an enlarged head, or severe head injury. Examine deliberately for the source of the fever and for meningism: bulging red eardrums, red pharynx, enlarged inflamed tonsils, neck stiffness, a bulging or tense fontanelle, and Brudzinski sign. Benzodiazepines are not recommended as a preventative measure between febrile episodes. 3. DIAZEPAM [add-on - not a substitute] Adult Not applicable - pediatric entry - Single rescue dose Peds 1 month to 5 years: 5 mg rectally. Repeat once after 5 minutes if the seizure continues. 6 to 11 years: 10 mg rectally. Repeat once after 5 minutes if the seizure continues. (Child 1 month–1 year: 5 mg rectally; Child 1–5 years: 5 mg rectally; Child 6–11 years: 10 mg rectally. Repeat once after 5 minutes if seizure continues. Administer as emergency rescue for seizure lasting >5 minutes. In Egypt, use IV diazepam ampoule content drawn into a syringe (without needle) and instilled rectally) Source Egyptian National Drug Formulary, nervous system 2025, diazepam monograph, febrile convulsions (printed p. 12) Why Home rescue medication for prolonged seizure (>5 minutes) Caution Indicated ONLY as emergency rescue for seizure lasting >5 minutes. There is a risk of respiratory depression; call emergency services immediately if seizure continues after 5 minutes post-diazepam. There is no rectal tube among the packs registered here - only ampoules and tablets. Rectal dosing means drawing the injection solution up and instilling it, which is normal practice locally but is worth knowing before you go looking for a preparation that does not exist. The formulary's route for a febrile convulsion is intravenous, 0.2-0.4 mg/kg with a second dose after ten minutes if needed, never more than 10 mg in one dose. Where a line can be got, that is the dose to use. Egypt VALPAM 5 MG/ML 3 AMP. AMOUN 6.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)