Parents’ perceptions and knowledge about fever and febrile seizures were determined by a questionnaire study at the Sophia Children’s Hospital, Rotterdam, The Netherlands. Of 230 parents of children who participated in a randomized controlled trial of ibuprofen to prevent recurrence of febrile seizures, 181 (79%) responded to the questionnaire. Each child had been treated in the emergency room because of a febrile seizure, and the risk factors for seizure recurrence included a positive family history of febrile seizures, a multiple type seizure, a temperature below 40.0°C at the initial seizure, and previous febrile seizure recurrence. The parents were informed of the generally benign nature of the febrile seizure, their prevalence, and the risk of seizure recurrence.

Of all respondents, only 13% were not afraid of fever, and 45% were afraid or very afraid. Parents of non-West European background were more afraid, and considered a temperature of 39.0°C as high fever. Child care measures taken by parents who were more afraid included more frequent temperature recordings (30% measured the temperature 5-8 times in 24 hours vs 14% for those less afraid), sleeping in the same room (36% vs 15%), and remaining awake at night (22% vs 5%). Only 5% had diazepam ready for use. Questioned about their thoughts at the moment of their child’s initial febrile seizure, 47% of parents thought the child was dying; only 8% were worried about epilepsy. When asked about their current thoughts of febrile seizures, 54% answered that they were harmful, mainly because they looked damaging. Of 44% of parents who considered febrile seizures not harmful, one half had been convinced by reassuring information received, mainly at the hospital outpatient clinic. Fear of a recurrence of febrile seizures in 44% of parents was significantly associated with fear of fever. [1]

COMMENT. Parents’ fear of a child’s impending death, alluded to in a 1968 monograph on Febrile Convulsions (Millichap JG, Macmillan), has apparently not changed in 30 years, despite the physicians’ reassurance and generally sanguine prognosis. Parental fear of fever and febrile seizures is a common occurrence, affecting almost 50% of families involved. Fever is feared because of its association with recurrence of a seizure. Those who are less afraid of fever and seizures attribute their reassurance to information received in a hospital clinic and not from the practitioner or child health center.

Comparing these results with a previous study involving the reaction of inexperienced parents to a child’s first febrile seizure, the frequency of fear of febrile seizures is similar [2]. Fear that the child would die during the seizure was volunteered by 44%, and another 33% admitted the same concern when specifically asked about it. General knowledge of febrile seizures was low, and many parents wished they had received more information about fever and the risks of febrile seizures. See Progress in Pediatric Neurology II, PNB Publ, 1994;pp19-20.

Few studies address the benefits and potential lessened anxiety of parents instructed in the use of rectal diazepam gel for the prevention and treatment of recurrent febrile seizures [3]. See Ped Neur Briefs June 1999; 13:46, for commentary on the efficacy and safety of Diastat in treatment of acute repetitive seizures.

The importance of parental education in the management of fever and febrile seizures is emphasized by these reports, and especially in families with a history of febrile seizures or epilepsy. Parental anxiety may be allayed by the prescription of intermittent diazepam given at times of fever, although poor compliance may lessen its effectiveness in practice.