Will My Baby Have Another Febrile Seizure?
The short answer
About 30-35% of children who have one febrile seizure will have at least one more during a future febrile illness. Risk factors for recurrence include having the first seizure before 18 months, having a lower fever at the time of the seizure, a family history of febrile seizures, and having the seizure early in the illness. Despite the recurrence risk, febrile seizures do not cause brain damage and do not significantly increase the risk of developing epilepsy (the risk rises only slightly, from about 1% to about 2-4%).
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By Age
What to expect by age
6-12 months
Babies who have their first febrile seizure before 12 months have a higher recurrence risk (up to 50%) compared to those whose first seizure occurs after 12 months. This is because they have more years of febrile illness ahead during the susceptible period (up to age 5). Despite this higher recurrence risk, each individual seizure is still almost always benign. Prophylactic anticonvulsant medications are generally not recommended by the AAP due to side effects outweighing benefits. Aggressive fever management with antipyretics has not been proven to prevent febrile seizures.
12-36 months
If your child had their first febrile seizure in this age range, the recurrence risk is around 30%. Each subsequent febrile illness may cause anxiety for parents, which is completely understandable. Having a seizure action plan can help: know how to position your child safely, time the seizure, and know when to call 911 (seizure lasting over 5 minutes). While you cannot prevent febrile seizures, you can prepare for them. Your pediatrician may prescribe rectal diazepam (Diastat) as a rescue medication for seizures lasting more than 5 minutes.
3-5 years
Children typically outgrow febrile seizures by age 5. If your child continues to have febrile seizures after age 5, or if seizures become complex (lasting more than 15 minutes, occurring more than once in 24 hours, or affecting only one side of the body), your pediatrician may recommend evaluation by a pediatric neurologist. The vast majority of children with febrile seizures develop normally and do not develop epilepsy. By school age, febrile seizures are usually a distant memory with no lasting effects.
What Should You Do?
When to take action
- Your child had one or two simple febrile seizures during different illnesses and has returned to normal each time.
- You feel anxious every time your child gets a fever - this is a very common and understandable parental response.
- Your child has developed normally despite having febrile seizures.
- Your child has had three or more febrile seizures and you want to discuss the overall pattern.
- You want to discuss whether a rescue medication prescription would be appropriate for your family.
- You have a strong family history of epilepsy and are concerned about your child's risk.
- Your child has a febrile seizure lasting more than 5 minutes - call 911 or administer prescribed rescue medication.
- Your child has multiple seizures within a 24-hour period.
- Your child has a seizure without fever, or a seizure that only affects one side of the body.
- Your child has a febrile seizure and afterward shows prolonged confusion, weakness on one side, or difficulty speaking.
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
What to Do During Your Baby's First Febrile Seizure
If your baby is having their first febrile seizure, stay calm. Place them on their side on a safe surface, do not put anything in their mouth, and time the seizure. Most febrile seizures last less than 5 minutes and stop on their own. Call 911 if the seizure lasts more than 5 minutes. After a first febrile seizure, your baby should always be evaluated by a doctor to confirm it was a febrile seizure and rule out other causes. Febrile seizures affect about 1 in 25 children and almost never cause lasting harm.
My Baby Had a Febrile Seizure
Febrile seizures are frightening to witness but are usually harmless. They affect about 1 in 25 children, typically between 6 months and 5 years, and almost never cause lasting harm. Most children who have one febrile seizure never have another, and they don't increase the risk of epilepsy significantly.
Early Signs of Epilepsy in Babies
Seizures in babies can look very different from seizures in older children or adults. Subtle signs may include repeated eye blinking or deviation, lip smacking, cycling leg movements, brief stiffening episodes, or clusters of head drops (infantile spasms). Infantile spasms are a neurological emergency that requires urgent evaluation. Not all unusual movements are seizures - babies commonly have benign tremors and startle reflexes - but any movement pattern that seems involuntary, repetitive, and cannot be interrupted deserves medical evaluation.
Baby Fever: When to Go to the Emergency Room
Any fever (100.4 degrees F / 38 degrees C or higher) in a baby under 3 months requires immediate medical evaluation, as it can indicate a serious infection. For babies 3-6 months, a fever above 102 degrees F (38.9 degrees C) warrants a call to your pediatrician. For babies over 6 months, how your baby is acting matters more than the number on the thermometer. A high fever alone does not mean an emergency, but fever combined with lethargy, difficulty breathing, or other concerning symptoms requires urgent care.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.