An AAP subcommittee on febrile seizures has revised the practice guidelines of 1996 for the diagnosis and evaluation of a simple febrile seizure in children 6 months through 60 months of age. Articles published since the last guideline through 2009 were reviewed, and recommendations were assessed until consensus was reached. The committee notes that the following do not indicate an exclusive course of treatment, and variations according to individual circumstances may be appropriate:

  • Identify the cause of fever;
  • Consider meningitis in the differential diagnosis;
  • Perform LP if the child is ill-appearing or there are clinical signs or symptoms of concern;
  • LP is an option in any infant 6-12 months of age who presents with a seizure and fever and who has not received immunization against Haemophilus influenzae type b or Streptococcus pneumoniae, or when immunization status cannot be determined;
  • LP is an option for children pretreated with antibiotics;
  • In general, further evaluation is not usually required, specifically EEG, blood studies or neuroimaging.

(AAP subcommittee on febrile seizures. Clinical practice guideline). [1]

COMMENT. In this revised guideline, compared to that published in 1999, specific indications for LP based primarily on age are modified. LP recommended in a child who is “ill-appearing” addresses the importance of clinical acumen of the treating physician, an indication omitted in the previous guidelines for children <18 months of age. It should be emphasized that these guidelines do not apply to children with complex febrile seizures.