Fever is one of the most common symptoms in children and is often a cause of significant concern for parents and caregivers. While fever itself is usually not dangerous, it is a natural response of the body to infection and serves as an indicator of an underlying process. However, in certain cases, fever may lead to complications such as febrile seizures, which can be alarming to witness.
What is Fever?
Fever is defined as an elevation of body temperature above the normal range, typically exceeding 100.4°F (38°C) when measured orally or rectally. The normal body temperature is approximately 97.5°F to 98.6°F (36.4°C to 37.0°C), although minor fluctuations occur due to circadian rhythm and physical activity.
Fever is not a disease in itself but a symptom of an underlying condition, most commonly infections. It results from the action of pyrogens (fever-inducing substances) that reset the hypothalamic thermoregulatory center to a higher temperature.
Causes of Fever in Children
Fever in children can arise from a variety of conditions. The most common causes include:
- Viral infections: such as influenza, common cold, roseola, and COVID-19.
- Bacterial infections: such as urinary tract infections, pneumonia, or ear infections.
- Immunization-related fever: mild fever is a common reaction to certain vaccines, including DTP and MMR.
- Other causes: autoimmune conditions, heat-related illness, and rare metabolic disorders.
Signs and Symptoms of Fever
Children with fever often present with both general and specific features. Common signs and symptoms include:
- Flushed skin and warmth to touch
- Diaphoresis (sweating)
- Chills or shivering episodes
- Restlessness or irritability
- Lethargy and decreased activity levels
- Loss of appetite
While fever itself is not harmful, it becomes concerning if associated with dehydration, breathing difficulty, persistent vomiting, or altered consciousness.
Management of Fever
The primary goal of fever management is comfort and hydration, rather than eliminating fever entirely. Fever can actually help fight infections by stimulating the immune system.
Key steps in management include:
Antipyretics: Ibuprofen or acetaminophen (paracetamol) are commonly used. Aspirin must be avoided in children due to the risk of Reye’s syndrome.Parents should remember that fever is self-limiting in most cases and resolves once the underlying infection is controlled.
Febrile Seizures: An Overview
A febrile seizure is a convulsion triggered by fever in children between 6 months and 5 years of age. Importantly, febrile seizures are not caused by intracranial infections, metabolic imbalances, or epilepsy, but rather by the rapid rise in body temperature.
While the episode can be extremely distressing for caregivers to witness, febrile seizures are usually benign and do not lead to long-term complications such as epilepsy or intellectual disability.
Signs and Symptoms of Febrile Seizures
The defining feature of febrile seizures is their occurrence in association with a sudden rise in body temperature.
Key clinical features include:
- Rapid increase in core temperature
- Generalized tonic-clonic seizure (stiffening followed by jerking movements)
- Eye rolling or loss of consciousness during the episode
- Postictal drowsiness — the child may appear sleepy or confused for some time after the seizure
Febrile seizures are typically short-lived, lasting less than 5 minutes, and usually resolve spontaneously.
Risk Factors for Febrile Seizures
Not all children with fever develop seizures. Certain factors increase the likelihood of febrile convulsions:
- Age: Highest incidence between 6 months and 5 years
- Rapid onset of fever: Faster temperature spikes are more likely to trigger seizures
- High fever: Seizures are more common with temperatures above 102°F (38.9°C)
- Family history: Genetic predisposition plays a role
- Certain vaccines: DTP (diphtheria, tetanus, pertussis) and MMR (measles, mumps, rubella) are occasionally associated with febrile seizures, usually within days of administration
Types of Febrile Seizures
Febrile seizures are classified into two categories:
1. Simple Febrile Seizures
- Last less than 15 minutes
- Do not recur within 24 hours
- Generalized (affecting the whole body)
2. Complex Febrile Seizures
- Last longer than 15 minutes
- May recur within the same illness episode
- May be focal (affecting only part of the body)
Complex febrile seizures are less common and may warrant further investigation to rule out other neurological causes.
Treatment of Febrile Seizures
Management is largely supportive. Since the seizures are self-limiting, aggressive treatment is usually unnecessary.
- Do not administer anticonvulsants routinely for febrile seizures.
- Rectal diazepam may be used if a seizure lasts longer than 5 minutes.
- Ensure the child is in a safe position during the seizure — lying on their side to prevent aspiration.
- Parents should be educated on seizure first aid and reassured that these episodes are generally harmless.
When to Seek Emergency Help
Parents should seek urgent medical help if:
- The seizure lasts longer than 5 minutes
- Seizures occur repeatedly during the same illness
- The child shows signs of serious infection (e.g., stiff neck, difficulty breathing, persistent vomiting, or rash)
- Postictal recovery is prolonged or abnormal
Prognosis and Long-Term Outlook
Most children who experience febrile seizures recover fully without long-term complications. The risk of developing epilepsy is slightly higher than in the general population, but the majority do not develop chronic seizure disorders. Recurrent febrile seizures may occur in about 30–35% of children, especially if the first seizure occurs before 1 year of age.
Prevention Strategies
While febrile seizures cannot always be prevented, the risk can be minimized through effective fever management:
- Treat fevers early with appropriate antipyretics.
- Keep the child hydrated and dressed in light clothing.
- Avoid overheating and ensure good ventilation during illness.
- Keep up-to-date with routine vaccinations, as vaccine-preventable diseases can trigger high fevers.
Table: Fever vs Febrile Seizure at a Glance
| Feature | Fever | Febrile Seizure |
|---|---|---|
| Definition | Elevated body temperature >38°C | Seizure triggered by fever |
| Symptoms | Flushed skin, chills, lethargy | Jerking movements, loss of consciousness |
| Duration | Varies (hours to days) | Usually less than 5 minutes |
| Risk Factors | Infections, vaccines, immunity | Age 6 months–5 years, family history, high fever |
| Treatment | Antipyretics, hydration, sponging | Supportive care, rectal diazepam if prolonged |
| Long-Term Effects | None (fever resolves with illness) | Usually none, rarely epilepsy risk |
FAQs on Fever and Febrile Seizures
Q1. Can febrile seizures cause brain damage?
No. Most febrile seizures are harmless and do not cause permanent brain injury.
Q2. How can parents distinguish between epilepsy and febrile seizures?
Febrile seizures only occur with fever and are age-limited. Epilepsy involves recurrent seizures without fever.
Q3. Should parents give antipyretics to prevent febrile seizures?
While antipyretics reduce fever discomfort, they do not guarantee seizure prevention.
Q4. Can a child experience multiple febrile seizures in one illness episode?
Yes, this is possible, especially in complex febrile seizures. Such cases require medical evaluation.
Q5. When should a child with fever be taken to the hospital immediately?
If the fever is accompanied by seizures lasting >5 minutes, breathing difficulty, stiff neck, persistent vomiting, or rash, immediate medical care is essential.
