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
  • ≥ 4 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
  • 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
Revised: October 2018 (Reviewed), February 2020
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