After being observed in the emergency department for four hours, Felix has recovered. He has had no further seizures and is now toddling around the ward, interested in all the toys. His gait is no different from before the seizure - in other words there is no evidence of ataxia.
Short term, we want to confirm the provisional diagnosis and ensure Felix has no further seizures. Time may reveal another focus for the fever. Long term, we will need to educate the family about febrile seizures and their management, and monitor Felix's developmental progress.
The initial impression is that Felix has had an uncomplicated febrile seizure. It was decided to observe him over the next few hours to ensure he had a complete return to normal consciousness. Explanation of the seizure to his father and mother and any other carers is important.
Paracetamol 15 mg/kg/dose to maximum 60 mg/kg/day to control fever (for comfort). There is good evidence that paracetamol does not reduce the incidence of febrile seizures.
15 minutely heart rate, respiratory rate, temperature and neurological observations initially, to hourly if satisfactory.
NSW Health basic clinical practice guidelines: Children and Infants with Seizures - Acute Management