NEW YORK (Reuters Health) – Updated practice guidelines issued by the American Academy of Pediatrics recommend a lumbar puncture if a child has a febrile seizure and there are signs or symptoms of possible meningitis. However, in general, EEGs, blood studies and neuroimaging are not usually necessary in cases of simple febrile seizure.

The guidelines are published in the February issue of Pediatrics and apply to the neurodiagnostic evaluation of children with a simple febrile seizure — not those with complex seizures or a previous CNS abnormality, the authors stress.

The updated guidance includes relevant studies published since the 1996 AAP guidelines. The Subcommitee on Febrile Disorders, which produced the guidelines, says the aim is to optimize evaluation of the child who has had a simple febrile seizure by detecting underlying diseases and, among other things, to educate physicians “to understand that a simple febrile seizure usually does not require further evaluation.”

The guidelines first address whether a lumbar puncture should be performed. The answer is affirmative in any child who presents with a seizure and a fever and has meningeal signs and symptoms.

For children 6-12 months of age with a fever and seizure, lumbar puncture is an option if the child has not received scheduled Hib or pneumococcal immunizations. “Although parents may not wish their child to undergo a lumbar puncture,” the authors note, “health care providers should explain that in the absence of complete immunizations, their child may be at risk of having fatal bacterial meningitis.”

A lumbar puncture is also an option when a child with a febrile seizure has been pretreated with antibiotics. That’s because antibiotic treatment can mask the signs and symptoms of meningitis.

The rest of the guidance focuses mainly on avoiding unnecessary tests and procedures.

Specifically, the subcommittee consensus indicates that an EEG should not be performed in the evaluation of a neurologically healthy child with a simple febrile seizure.

Also, measurement of serum electrolytes, calcium, phosphorus, magnesium, blood glucose or complete blood cell count should not be performed routinely solely to identify the cause of a simple febrile seizure.

Furthermore, the guidelines state, “Neuroimaging should not be performed in the routine evaluation of the child with a simple febrile seizure.”

Although parents may want such tests performed to explain the seizure, they should be reassured that the tests will not alter the outcome for their child, the authors advise.

Pediatrics 2011;127:389–394.