Outpatient Pathway for the Child with Febrile Seizure without Neurological Disease
  • Concerning Features
  • Focality or Todd's paralysis lasting
    > 15 min
  • ≥ 4 seizures in 24 hours
  • Duration > 15 minutes
  • Duration > 5 min + benzodiazepine
  • Failure to return to baseline mental status
  • Significant developmental delay
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Assess for meningitis/intracranial/head or neck infection
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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
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Patient currently well, but has history of complex febrile seizure with concerning features
Discharge Criteria/Instructions/Follow-up Recommendations
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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
  • 5 or more episodes of febrile seizures in lifetime
  • 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
Reviewed: October 2018
Authors: J. Hart, MD; M. Blackstone, MD; K. Dorland, RN; D. Bearden, MD; M. Sergonis MD; V. Scheid MD;
T. Kaur MD; S. Haas MD; and L. Adang MD