Outpatient Specialty Care and Primary Care Clinical Pathway for Children with Febrile Seizures without Neurologic Disease
- For Active Seizure:
- Call 911
- Midazolam – 0.3 mg/kg buccal OR
0.2 mg/kg IM for seizures > 5 min - Monitor support, ABCs
- Status Epilepticus Pathway
- Concerning Features
- Focality or Todd's paralysis lasting > 15 min
- ≥ 3 seizures in 24 hours
- Duration > 15 minutes
- Duration > 5 min + benzodiazepine
- Failure to return to baseline mental status
- Significant developmental delay
Assess for meningitis/intracranial/head or neck infection
ED Referral
- Care is guided by History and Physical Examination to identify fever source and concerning features.
- Routine lab tests are not recommended for simple febrile seizures or complex febrile seizures without concerning features.
- Laboratory testing should focus on age appropriate fever evaluation guided by H&P.
- AAP Guidelines for Febrile Seizures
- Consider Referral to ED
- Fever source requires further evaluation or treatment
Patient currently well, but has history of complex febrile seizure with concerning features
Discharge Criteria/Instructions/Follow-up Recommendations
Neurology Referral
- Return to neurological baseline
- Well-appearing, tolerating PO
- Fever source does not require further evaluation or inpatient treatment
- Parental concerns addressed
- Follow-up plan established
- Discharge instructions
- See Patient Family Education
- Consider neurology referral if a patient has ≥ 2 lifetime complex febrile seizure episodes with or without concerning features or ≥ 3 lifetime simple febrile seizure episodes
- Significant developmental delay
- Parental report of complex seizure with concerning features that occurred more than 24 hours ago and child back to baseline
- Outpatient MRI if clearly focal and no ED referral made
Posted: June 2016
Revised: December 2020
Authors: J. Hart, MD; M. Blackstone, MD; V. Scheid, MD; T. Kaur, MD; S. Haas, MD; P. Mcdonnell, MD; L. Fried, MD; J. Burns, MD; K. Murphy, DO
Revised: December 2020
Authors: J. Hart, MD; M. Blackstone, MD; V. Scheid, MD; T. Kaur, MD; S. Haas, MD; P. Mcdonnell, MD; L. Fried, MD; J. Burns, MD; K. Murphy, DO