Emergency Department and Inpatient Clinical Pathway
for Evaluation/Treatment of Children with Febrile Seizures
Without Neurologic Disease
Actively seizing
Status Epilepticus Pathway
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
- Care is guided by History and Physical Examination to identify fever source and concerning features.
- Routine lab tests, neuroimaging and EEG, 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
ED Evaluation
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
Evidence
- Yield of Emergent Neuroimaging Among Children Presenting with a First Complex Febrile Seizure.
- Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society
Media
- Primary Care Perspectives: Podcast for Pediatricians
Episode 69: Recognizing and Treating Febrile Seizures