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It may be decided that lumbar puncture is contraindicated in a febrile child who does not
return to normal consciousness after a prolonged convulsion  there is a risk of coning if the
intracranial pressure is raised. In a retrospective review of the progress of 445 children
admitted to hospital with bacterial meningitis Rennick et al67 concluded that lumbar puncture
may cause cerebral herniation in some cases, and normal results on computed tomography
do not mean that it is safe to perform a lumbar puncture in a child with bacterial meningitis.
It may be appropriate to start adequate doses of broad-spectrum antibiotics and delay the
lumbar puncture.

EEG
Reviewers have concluded that EEGs are not helpful in assessing the prognosis of children
who have febrile convulsions17,19,57,68. The EEG is therefore not recommended as part of the
assesssment of a child with febrile convulsions.

Brain imaging

A child with a preceding or underlying neurological problem may first come to
medical attention because of a febrile convulsion. Underlying pathology may
therefore be suspected on the basis of the history or examination and it may then be
appropriate to perform a scan to investigate. This situation will exist in only a small
minority of children with febrile convulsions.

Acute therapy

Management of fever
Fever should be treated for the comfort of the child. Kinmonth et al69 found that advice to
give paracetamol was more effective than sponging or unwrapping in controlling temperature
in children at home and was more acceptable to parents. The RCP/BPA Joint Working Group
did not recommend physical methods such as fanning, cold bathing and tepid sponging61.

Rectal diazepam to abort febrile convulsions
The home use of rectal diazepam to abort seizures in children with convulsive disorders has
been shown to be effective70-72. Some members of the RCP/BPA Joint Working Group (1991)
advised parents to give the drug as soon as possible, some advised that the parents wait for
five minutes, by which time most convulsions will have stopped and the drug will be
unnecessary. There is now evidence that buccal midazolam is as safe and effective in
controlling febrile seizures as rectal diazepam73.

Prophylactic treatment

Intermittent prophylaxis
One approach to preventing recurrent febrile convulsions is to intervene at the onset of febrile
illnesses in the child at risk. Active steps to lower the body temperature have been advocated
and so has the prophylactic use of diazepam.

Antipyretic measures. Camfield et al74 studied antipyretic instruction plus either
phenobarbitone or placebo to prevent recurrence after the first febrile seizure. Despite verbal
and written instructions about temperature control and demonstration of the use of the
thermometer, there was little evidence that antipyretic counselling decreased seizure
recurrence amongst patients receiving placebo. The MRC/BPA working group met in 1990
and at that time the members knew of no evidence that antipyretic treatment influenced the
recurrence of febrile seizures61. In an editorial Camfield et al75 concluded that there was no
evidence that the usual methods of fever control have any effect on recurrences of febrile
seizures. In their opinion the continuing recommendation that parents document fever and