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: October 2018 (Reviewed), February 2020, 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