Epilepsy in Children: A First-Seizure Guide for Parents

Watching your child have a seizure for the first time is frightening, and most parents remember every second of it. Here is the most important thing to know first: one seizure does not mean your child has epilepsy. Many first seizures are triggered by fever or a passing illness and never happen again. Epilepsy is usually diagnosed only when seizures repeat without an obvious trigger, or when tests show a high chance that they will. This guide covers what to do during a seizure, when to call an ambulance, how doctors decide whether it is epilepsy, which tests your child may need, and what life looks like if the answer is yes.

What Should You Do During Your Child’s Seizure?

Your job during a seizure is to keep your child safe and to watch carefully. You cannot stop a seizure once it starts, and trying to do so can cause injury. These steps follow the CDC’s seizure first-aid advice (CDC, First Aid for Seizures). They are for a seizure with stiffening or jerking. If your child instead stares, does not respond, or makes repeated movements such as lip-smacking, stay with them, keep them away from roads, stairs and water, time it, and use the same 108 rules.

1. Stay calm and note the time the seizure started.
2. Ease your child to the floor if they are falling, and move hard or sharp objects away.
3. Turn them gently onto one side, mouth pointing towards the ground, so saliva or vomit can drain and the airway stays clear.
4. Put something soft and flat under their head, such as a folded towel.
5. Loosen anything tight around the neck, and remove spectacles.
6. Record a short phone video if another adult is present to help. Doctors find a video of the event extremely useful.
7. Stay with your child until they are fully awake. They may sleep deeply afterwards, but they should breathe normally and become easier to wake over time. If they are hard to wake, breathe noisily or irregularly after the jerking stops, or cannot move one side of the body, call 108.

What should you never do during a seizure?

• Do not put anything in the mouth: no spoon, finger, cloth or medicine. A child cannot swallow their tongue, and objects can break teeth or block the airway.
• Do not hold them down or try to stop the jerking movements.
• Do not give water, food or tablets until your child is fully alert, because they can choke.
• Skip traditional remedies. Placing keys or iron in the hand, or making the child smell a shoe or onion, does not shorten a seizure. It only takes your attention away from keeping the child safe.

When Should You Call an Ambulance?

The 5-minute rule matters because seizures that run longer become less likely to stop by themselves and need emergency medicine. The International League Against Epilepsy (ILAE) says a convulsive seizure lasting 5 minutes should be treated as continuous seizure activity, called status epilepticus, and that after about 30 minutes there is a risk of long-term consequences (Trinka et al., Epilepsia, 2015). Most seizures in children stop well before that, but timing the seizure is how you know which kind you are dealing with.

Was It a Seizure, and Is It Epilepsy?

Doctors answer two questions after a first event. The first is whether it was a seizure at all. Several other conditions, most of them harmless, can look like one in children: fainting, breath-holding spells in toddlers, night terrors, reflux in infants, and daydreaming that is mistaken for absence seizures. Fainting during exercise or without any warning should still be checked, because it can occasionally come from the heart. A clear description and a phone video often settle this quickly.

The second question is whether the seizure was provoked, meaning triggered by something temporary such as fever, very low blood sugar, a head injury or an infection of the brain, or unprovoked, with no immediate cause. Provoked seizures are not epilepsy. The ILAE defines epilepsy in three ways. A child has epilepsy after two unprovoked seizures more than 24 hours apart. One unprovoked seizure also counts if tests show at least a 60% chance of another over the next ten years. So does a recognised epilepsy syndrome (Fisher et al., Epilepsia, 2014).

What is a febrile seizure?

A febrile seizure is a seizure triggered by fever of 38°C or above in a child aged 6 months to 5 years, without an infection of the brain. They are the most common type of seizure in young children, affecting 2% to 5% of children in that age group. A simple febrile seizure involves the whole body, lasts less than 15 minutes, and does not happen again within 24 hours. The 15-minute limit is how doctors classify the seizure afterwards. It is not a reason to wait: any seizure lasting 5 minutes, with or without fever, needs 108.

According to the American Academy of Pediatrics, a child with a simple febrile seizure usually does not need an EEG, blood tests or brain imaging. The doctor’s main job is to find the cause of the fever and make sure it is not meningitis; in babies aged 6 to 12 months whose Hib or pneumococcal vaccines are missing or unknown, the doctor may suggest a lumbar puncture (AAP Subcommittee on Febrile Seizures, Pediatrics, 2011).

Paracetamol can make a feverish child more comfortable; give only the dose for your child’s weight on the label or as your doctor advises. One point surprises many parents, though: a Cochrane review found no significant benefit from fever medicines such as ibuprofen in preventing febrile seizures from coming back (Offringa et al., Cochrane, 2021). If your child has a febrile seizure despite your care, it is not because you treated the fever too late.

Will Your Child Have Another Seizure?

Possibly, but most children do not, at least in the first year. A 2023 Cochrane review pooled 46 studies of people who had a first unprovoked seizure and found that 27% had another within 6 months, 36% within a year and 43% within two years. Figures were slightly higher in the children’s studies and slightly lower in adults (Neligan et al., Cochrane Database of Systematic Reviews, 2023).

The EEG changes these odds more than anything else. A 2025 report from the International League Against Epilepsy and the International Federation of Clinical Neurophysiology pooled 22 studies covering 4,847 patients. Seizures came back in 60% of patients whose EEG showed epileptic discharges, against 40% of those whose EEG did not. In children the link was especially strong, with odds of recurrence more than three times higher when discharges were present (Baykan et al., Clinical Neurophysiology Practice, 2025).

A 2025 Cochrane review also linked abnormal brain imaging, a first seizure that happened during sleep, a family history of epilepsy, and temporary weakness after the seizure to a higher chance of another one, though the certainty of most of these findings was low (Adan et al., Cochrane, 2025).

Which Tests Will Your Child Need?

Not every child needs every test. The paediatric neurologist chooses based on your child’s age, what the seizure looked like, and the examination. In the UK, NICE recommends that a child who has recovered from a suspected first seizure is seen by a paediatrician with expertise in seizures within two weeks (NICE guideline NG217, 2022). That is a reasonable benchmark for families anywhere.

Two points are worth knowing. First, a normal EEG does not rule out epilepsy; NICE specifically warns against using EEG to exclude the diagnosis. Second, if your child’s episodes are hard to describe or keep happening without a clear answer, a video EEG records an actual episode together with the brain’s activity at that moment.

A cause to know about in India: neurocysticercosis

In India, one well-known cause of seizures in children is neurocysticercosis, an infection in which larvae of the pork tapeworm settle in the brain. The World Health Organization estimates that it causes about 30% of epilepsy cases in many areas where the tapeworm is common (WHO fact sheet). The eggs spread through contaminated food, water and hands, so vegetarian children can be affected too. It shows up on a CT or MRI scan, and it is treatable. Hand washing and washing raw vegetables well are the main protection.

Does Every Child Need Medicine After a First Seizure?

No. After a single unprovoked seizure with a normal EEG and normal examination, many paediatric neurologists advise waiting and watching, because, as the figures above show, many children will not have another seizure in the next two years, and every medicine has side effects. Medicine is more likely to be recommended when the EEG shows epileptic discharges, when there is a structural cause on the scan, or after a second unprovoked seizure. This is a shared decision; ask your doctor to explain the risk of another seizure with and without treatment for your child specifically.

When medicine is started, the outlook is good. The WHO estimates that up to 70% of people with epilepsy could become seizure-free with appropriate antiseizure medicine (WHO). In a 30-year Glasgow study of 1,795 people with newly diagnosed epilepsy, most of them adults, about half became seizure-free on the first medicine they tried, and 63.7% were seizure-free for at least a year by the end of follow-up (Chen et al., JAMA Neurology, 2018). Several childhood epilepsy syndromes also settle on their own as the child grows. Never stop or change a medicine without the doctor’s advice, because stopping suddenly can trigger seizures.

How Do You Keep Your Child Safe Day to Day?

Most children with epilepsy go to school, play sport and live normal lives. A few sensible precautions cover most of the risk:

• Water. Young children should be watched for the whole of every bath, including bucket baths, and never left alone near a filled bucket or tub. Older children should shower or take a bucket bath rather than a tub bath, with the door unlocked. Swim only with an adult who can swim close by, and avoid the sea, rivers and ponds unless your doctor agrees.
• Heights and wheels. Use a helmet for cycling, and avoid climbing high trees, walls or terraces without supervision.
• Sleep. Lack of sleep is a common seizure trigger. Keep regular bedtimes, especially around exams.
• School. Tell the class teacher, share the first-aid steps above, and make sure the school has your phone number.
• A seizure diary. Note the date, time, length and any trigger for each event. Bring it, and any videos, to each appointment.
• A rescue plan. If your child has had a long seizure, the doctor may prescribe an emergency medicine, such as midazolam given into the cheek or nose, and show you exactly when and how to use it.

Epilepsy is a medical condition of the brain. It is not contagious, not a curse, and not caused by anything parents did wrong. Many families find strength in prayer, and that can sit alongside treatment, but rituals should never replace medicine or delay a doctor’s visit. Children with well-controlled epilepsy can study, work and raise families like anyone else.

Paediatric Epilepsy Care at First Neuro Hospitals

Children with seizures at First Neuro are seen by consultant paediatric neurologist Dr. Shruthi N.M. (MD Paediatrics; DM Paediatric Neurology, AIIMS New Delhi), whose special interests include paediatric epilepsy and paediatric EEG and electrophysiological studies. The hospital’s 128-channel video EEG system means that EEG and video monitoring can be done on site, and the paediatric neurology department works with neurosurgery, rehabilitation and counselling services when a child needs more than medicine. Paediatric neurology consultations are also listed at our Kasaragod centre for families in North Kerala.

Frequently Asked Questions

Is a febrile seizure the same as epilepsy?

No. A febrile seizure is triggered by fever in a child between 6 months and 5 years, and it is a provoked seizure, not epilepsy. Most children who have febrile seizures grow out of them and never develop epilepsy.

Can a seizure damage my child’s brain?

Brief seizures, including typical febrile seizures, are not known to cause brain damage. Very long seizures are different, which is why any seizure lasting more than 5 minutes needs emergency treatment.

Can a child swallow their tongue during a seizure?

No. This is a common myth. Putting a spoon, cloth or finger in the mouth is what causes harm. Turn the child on their side instead, so the airway stays clear.

Will my child outgrow epilepsy?

Many children do. Some childhood epilepsy syndromes are known to settle by the teenage years, and many children who become seizure-free on medicine can later stop it under medical supervision. Your paediatric neurologist can tell you what is expected for your child’s type of epilepsy.

Should my child stop going to school after a seizure?

Usually not. Once your child has recovered and been assessed, most can return to school. Tell the teachers what happened and share the first-aid steps, and ask your doctor about any specific activities to avoid until a diagnosis is clear.

One Seizure Is a Question, Not a Diagnosis

A first seizure starts a process of finding out, not a lifelong label. Keep your child safe during the event, time it, call 108 if it passes 5 minutes, and if it was the first one, get them checked at an emergency department straight away. Then see a paediatric neurologist with your video and notes. Whether the answer is a one-off febrile seizure or epilepsy that needs treatment, the outlook for most children is good. If you also care for an older relative, our guide to stroke warning signs is worth reading, and our neurology department treats epilepsy in adults.

Please note: this article is general information for parents and does not replace a doctor’s assessment. Every child who has a first seizure should be examined by a doctor straight away. Call 108 or 112 for any seizure lasting more than 5 minutes, repeated seizures, breathing difficulty, or a child who does not wake up normally. Do not start, stop or change any medicine without your doctor’s advice.