Febrile seizure is a common acute neurological event in childhood and is typically defined as a seizure occurring in association with fever in children between 6 months and 5 years of age, without evidence of central nervous system infection, metabolic disturbance, or previous afebrile seizure [1,2]. It represents one of the most frequent causes of emergency visits in paediatric practice. The episode is often brief and self-limited, but the sudden onset of convulsions in a febrile child creates substantial anxiety among parents and caregivers. From a clinical viewpoint, febrile seizures occupy an important position because they require careful distinction from meningitis, encephalitis, epilepsy, electrolyte imbalance, and other acute symptomatic seizures [3,4]. Febrile seizures are usually classified as simple or complex. A simple febrile seizure is generalized, lasts less than 15 minutes, and does not recur within 24 hours. A complex febrile seizure is characterized by focal onset or focal features, duration of 15 minutes or more, or recurrence within the same febrile illness or within 24 hours [3,4]. This distinction is clinically relevant because complex febrile seizures require closer observation, selective investigation, and structured follow-up. Nevertheless, the overall prognosis remains favourable in most children, particularly in those with normal development and no abnormal neurological findings [5-7]. The clinical expression of febrile seizures is influenced by age, sex, genetic susceptibility, fever characteristics, underlying infection, nutritional status, and past seizure history. Previous studies have shown that younger age at first seizure, family history of febrile seizures, lower fever threshold, and short duration of fever before seizure onset are associated with recurrence [8]. Complex seizure features, neurodevelopmental delay, and family history of epilepsy are important variables while assessing the future risk of epilepsy [9,10]. Iron deficiency anemia has also attracted attention as a potentially modifiable risk factor, although reported associations vary across populations and study designs [12-14]. In routine paediatric settings, most children with febrile seizures present with infections such as upper respiratory tract infection, gastroenteritis, lower respiratory tract infection, urinary tract infection, or otitis media. Current evidence-based recommendations emphasize focused clinical assessment, identification of fever source, exclusion of central nervous system infection when clinically suspected, and avoidance of unnecessary neuroimaging or electroencephalography in typical simple febrile seizures [4,11]. A hospital-based description of local clinical patterns helps clinicians plan appropriate evaluation, counsel parents, and identify children who need admission or closer observation. The present study was conducted with the objective of assessing the clinical profile, risk factors, laboratory findings, and short-term outcomes of febrile seizures among children aged 6 months to 5 years presenting to a tertiary care teaching hospital. The study also aimed to describe the distribution of simple and complex febrile seizures, common sources of fever, associated clinical and laboratory factors, recurrence during hospital stay, admission requirement, neurological status at discharge, and mortality.

Study design and setting: This hospital-based observational study was conducted in the Department of Paediatrics, Konaseema Institute of Medical Sciences & Research Foundation, Amalapuram, Andhra Pradesh, India. The institute functions as a tertiary care teaching hospital and caters to children from Amalapuram and adjoining Konaseema regions through outpatient, emergency, inpatient, laboratory, and supportive paediatric services. The study was carried out over a six-month period from June 2020 to November 2020. Study population and sample size: The study included 100 children aged 6 months to 5 years who presented with febrile seizures during the study period. Children were enrolled after clinical evaluation and confirmation that the seizure occurred in association with fever. The sample size represented the eligible cases available during the defined hospital-based study period. Inclusion and exclusion criteria: Children aged 6 months to 5 years with seizure associated with fever were included. Children with previous afebrile seizures, known epilepsy, central nervous system infection, acute metabolic disturbance, severe electrolyte derangement causing seizure, structural brain disease, or incomplete clinical records were excluded. Children outside the defined age range were also excluded. These criteria were applied to ensure that the study population represented febrile seizures according to accepted clinical definitions [1,3,4]. Data collection procedure: Data were collected using a structured study proforma. The recorded variables included age, sex, temperature at presentation, duration of fever before seizure, seizure type, seizure semiology, seizure duration, number of episodes within 24 hours, source of fever, previous history of febrile seizures, family history of febrile seizures, family history of epilepsy, developmental delay, prematurity or low birth weight history, immunization status, and relevant laboratory findings. Operational definitions and assessment: Simple febrile seizure was defined as a generalized seizure lasting less than 15 minutes and occurring once within 24 hours. Complex febrile seizure was defined by focal features, duration of more than 15 minutes, or more than one seizure episode within 24 hours [3,4]. Fever source was assigned after clinical examination and relevant investigations. Iron deficiency anemia was considered when hemoglobin was below 11 g/dL with clinical or laboratory features suggestive of iron deficiency, as documented in the case record. Laboratory evaluation and outcome measures: Laboratory assessment included hemoglobin, total leukocyte count, serum sodium, and random blood sugar, as clinically indicated. Additional tests were performed based on the suspected source of fever and physician judgement. Outcome variables included discharge after observation, need for hospital admission, seizure recurrence during hospital stay, requirement of anticonvulsant therapy beyond acute management, neurological deficit at discharge, and mortality. Statistical analysis and ethics: Data were entered into a spreadsheet and analysed using descriptive statistics. Categorical variables were expressed as frequency and percentage, while continuous variables were summarized as mean and standard deviation. As the study was descriptive in design, no inferential comparison was planned. Institutional ethical approval and parental or guardian consent should be documented in the final submission file according to journal requirements.

A total of 100 children aged 6 months to 5 years with febrile seizures were included in the study. The mean age of the children was 25.8 ± 13.6 months. The highest proportion of cases was observed in the 13-24 months age group, accounting for 38% of the study population. Male children were more commonly affected than female children, with a male-to-female ratio of 1.4:1. The baseline demographic profile is shown in Table 1. Table 1. Baseline demographic profile of children with febrile seizures Variable Number of children Percentage Age group 6-12 months 22 22.0% 13-24 months 38 38.0% 25-36 months 24 24.0% 37-60 months 16 16.0% Sex Male 58 58.0% Female 42 42.0% Total 100 100.0% Simple febrile seizures were observed in 72 children, while 28 children had complex febrile seizures. Generalized tonic-clonic seizures were the most frequent seizure pattern. Most children had a single seizure episode within 24 hours, and seizure duration was less than 5 minutes in nearly two-thirds of the cases. The clinical profile of febrile seizures is presented in Table 2. Table 2. Clinical profile of febrile seizures Clinical parameter Number of children Percentage Type of febrile seizure Simple febrile seizure 72 72.0% Complex febrile seizure 28 28.0% Seizure semiology Generalized tonic-clonic seizure 81 81.0% Focal seizure 12 12.0% Atonic/other seizure type 7 7.0% Duration of seizure <5 minutes 64 64.0% 5-15 minutes 25 25.0% >15 minutes 11 11.0% Number of seizures in 24 hours Single episode 76 76.0% Multiple episodes 24 24.0% The most common source of fever was upper respiratory tract infection, observed in 43% of children. This was followed by acute gastroenteritis, lower respiratory tract infection, urinary tract infection, and otitis media. Fever without a definite localizing focus was observed in 10% of children. Among the evaluated risk factors, iron deficiency anemia was the most frequent, followed by previous history of febrile seizures and family history of febrile seizures. The source of fever and associated risk factors are summarized in Table 3. Table 3. Source of fever and associated risk factors Variable Number of children Percentage Source of fever Upper respiratory tract infection 43 43.0% Acute gastroenteritis 18 18.0% Lower respiratory tract infection 15 15.0% Urinary tract infection 9 9.0% Otitis media 5 5.0% Fever without localizing focus 10 10.0% Risk factors Iron deficiency anemia 36 36.0% Previous history of febrile seizures 31 31.0% Family history of febrile seizures 26 26.0% Prematurity/low birth weight history 12 12.0% Incomplete immunization status 9 9.0% Developmental delay 8 8.0% Family history of epilepsy 7 7.0% Most children had favourable short-term outcomes. Eighty-six children recovered without any immediate neurological deficit and were discharged after observation and treatment of the underlying febrile illness. Fourteen children required admission for prolonged observation, recurrent seizures, or management of associated infection. Seizure recurrence during hospital stay was noted in 8% of children. No neurological deficit at discharge or mortality was recorded. Laboratory findings and clinical outcomes are shown in Table 4. Table 4. Laboratory findings and clinical outcomes Parameter Number of children Percentage Laboratory findings Hemoglobin ≥11 g/dL 64 64.0% Hemoglobin <11 g/dL 36 36.0% Normal total leukocyte count 71 71.0% Leukocytosis 29 29.0% Normal serum sodium 88 88.0% Hyponatremia 12 12.0% Normal random blood sugar 96 96.0% Hypoglycemia 4 4.0% Clinical outcomes Discharged after observation 86 86.0% Required hospital admission 14 14.0% Recurrence during hospital stay 8 8.0% Required anticonvulsant therapy beyond acute management 11 11.0% Neurological deficit at discharge 0 0.0% Mortality 0 0.0% Overall, febrile seizures were most commonly observed among male children aged 13-24 months. Simple febrile seizures formed the predominant clinical type. Upper respiratory tract infection was the leading source of fever. Most children had complete recovery with no immediate neurological complications or mortality.

The present hospital-based observational study described the clinical profile, risk factors, laboratory findings, and short-term outcomes of febrile seizures among 100 children aged 6 months to 5 years. The mean age was 25.8 ± 13.6 months, and the highest proportion of cases occurred in the 13-24 months age group. This age concentration agrees with previous literature showing that febrile seizures peak during the second year of life, when neuronal excitability, fever response, and immune exposure intersect during early childhood [1,2,5]. Male predominance was observed in the present study, with males constituting 58% of the sample. A slight male excess has also been reported in several clinical descriptions of febrile seizures [1,6]. Simple febrile seizures formed the major clinical type in this study, accounting for 72% of cases, while complex febrile seizures accounted for 28%. This distribution is consistent with the established observation that simple febrile seizures are more frequent than complex febrile seizures in general paediatric practice [3,7]. Generalized tonic-clonic seizure was the most common semiology, and most children experienced a single episode within 24 hours. These findings support the clinical principle that most febrile seizures are short, generalized, and self-limiting. However, the presence of complex features in more than one-fourth of children highlights the need for careful history-taking and short-term monitoring [9,10]. Upper respiratory tract infection was the leading source of fever, followed by acute gastroenteritis and lower respiratory tract infection. This pattern reflects the high frequency of viral and bacterial infections during early childhood and is in agreement with recommendations that evaluation should focus on identifying the cause of fever rather than routine neurological testing in typical simple febrile seizures [4,11]. Fever without a localizing focus was observed in 10% of children, emphasizing the value of repeat clinical assessment during observation. Iron deficiency anemia was the most frequently identified risk factor in this cohort, present in 36% of children. The association between iron deficiency and febrile seizures has been reported in earlier case-control studies and meta-analyses, although differences in nutritional status, diagnostic thresholds, and background anemia prevalence influence observed results [12-14]. Previous history of febrile seizures and family history of febrile seizures were also common, supporting the recognized contribution of recurrence tendency and familial susceptibility [7,8]. Developmental delay and family history of epilepsy were less frequent but clinically important variables for follow-up counselling. The short-term outcome was favourable. Most children were discharged after observation, 14% required admission, and no mortality or neurological deficit at discharge was recorded. These findings align with guideline-based understanding that febrile seizures are generally benign when central nervous system infection and other acute symptomatic causes are excluded [3-6]. Recurrence during hospital stay occurred in 8% of children, reinforcing the need for parent education on seizure first aid, fever care, warning signs, and follow-up after discharge. The findings support a balanced approach: avoiding unnecessary investigations in simple cases while maintaining vigilance in children with complex features or recurrent episodes. Limitations The study had a single-centre, hospital-based design with a modest sample size of 100 children, limiting wider population-level inference. Follow-up was restricted to the hospital stay, so long-term recurrence and later epilepsy risk were not assessed. Detailed iron profile, inflammatory markers, viral testing, electroencephalography, and neuroimaging were not uniformly performed. Fever etiology was based on clinical and available laboratory evaluation.

Febrile seizures in this cohort were most frequent among children aged 13-24 months and showed male predominance. Simple febrile seizures were the principal clinical type, and generalized tonic-clonic seizures were the commonest semiology. Upper respiratory tract infection was the leading fever source. Iron deficiency anemia, previous febrile seizure history, and family history of febrile seizures were common associated factors. Most children had favourable short-term recovery, with low in-hospital recurrence and no mortality or neurological deficit at discharge. Hospital-based assessment should prioritize identification of fever source, recognition of complex seizure features, correction of modifiable risk factors, and structured parental counselling before discharge. These observations support practical, locally relevant paediatric decision-making.

1. Leung AKC, Hon KL, Leung TNH. Febrile seizures: an overview. Drugs Context. 2018 Jul 16;7:212536. doi: 10.7573/dic.212536. PMID: 30038660. 2. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child. 2004 Aug;89(8):751-756. doi: 10.1136/adc.2003.028449. PMID: 15269077. 3. Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008 Jun;121(6):1281-1286. doi: 10.1542/peds.2008-0939. PMID: 18519501. 4. Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011 Feb;127(2):389-394. doi: 10.1542/peds.2010-3318. PMID: 21285335. 5. Smith DK, Sadler KP, Benedum M. Febrile seizures: risks, evaluation, and prognosis. Am Fam Physician. 2019 Apr 1;99(7):445-450. PMID: 30932454. 6. Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M. Febrile seizures. BMJ. 2015 Aug 18;351:h4240. doi: 10.1136/bmj.h4240. PMID: 26286537. 7. Shinnar S, Glauser TA. Febrile seizures. J Child Neurol. 2002 Jan;17 Suppl 1:S44-S52. doi: 10.1177/08830738020170010601. PMID: 11918463. 8. Berg AT, Shinnar S, Darefsky AS, Holford TR, Shapiro ED, Salomon ME, et al. Predictors of recurrent febrile seizures. A prospective cohort study. Arch Pediatr Adolesc Med. 1997 Apr;151(4):371-378. doi: 10.1001/archpedi.1997.02170410045006. PMID: 9111436. 9. Berg AT, Shinnar S. Complex febrile seizures. Epilepsia. 1996 Feb;37(2):126-133. doi: 10.1111/j.1528-1157.1996.tb00003.x. PMID: 8635422. 10. Offringa M, Moyer VA. Evidence based management of seizures associated with fever. BMJ. 2001 Nov 10;323(7321):1111-1114. doi: 10.1136/bmj.323.7321.1111. PMID: 11701580. 11. Kimia AA, Bachur RG, Torres A, Harper MB. Febrile seizures: emergency medicine perspective. Curr Opin Pediatr. 2015 Jun;27(3):292-297. doi: 10.1097/MOP.0000000000000220. PMID: 25944308. 12. Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D'Apuzzo A, et al. Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years. BMJ. 1996 Aug 10;313(7053):343. doi: 10.1136/bmj.313.7053.343. PMID: 8760744. 13. Daoud AS, Batieha A, Abu-Ekteish F, Gharaibeh N, Ajlouni S, Hijazi S. Iron status: a possible risk factor for the first febrile seizure. Epilepsia. 2002 Jul;43(7):740-743. doi: 10.1046/j.1528-1157.2002.32501.x. PMID: 12102677. 14. Kwak BO, Kim K, Kim SN, Lee R. Relationship between iron deficiency anemia and febrile seizures in children: a systematic review and meta-analysis. Seizure. 2017 Nov;52:27-34. doi: 10.1016/j.seizure.2017.09.009. PMID: 28957722.