Febrile Seizure in a Child Aged Under 3 Years: What Is the Treatment?

Clinical Scenario

This protocol covers the acute management of a febrile seizure presenting in a child aged less than 3 years. This age group carries specific therapeutic considerations that distinguish it from older children, particularly in terms of preferred route and agent selection.

Treatment Approach

When intravenous access is established, an intravenous benzodiazepine represents the first-line intervention. Evidence supports more than one agent within this class, with comparative data available on their relative effectiveness. The complete regimen — including agent selection, sequencing, and all clinical decision points — is set out in the full protocol.

Specific agents, doses, and escalation steps are detailed behind the link below.

Treatment Goal

Termination of the febrile seizure — achieving prompt, safe seizure cessation.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1186/s13052-024-01666-1

The recommendation is to prefer rectal DZP for children aged less than 3 years (at a dose of 5 mg) with a subsequent switch to buccal MDZ.
If intravenous access is available, other BDZs could be considered.
For example, a Cochrane review published in 2018 concluded that intravenous lorazepam (0.1 mg/kg/dose; max 4 mg/dose) and diazepam (0.2 mg/kg/dose; max 10 mg) have similar rates of seizure cessation and potential respiratory depression.
Another option is intravenous midazolam (0.2 mg/kg/dose; max 10 mg).

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