"I thought she was dying" — explaining a febrile seizure

PLAB 2 & PRES 3 · paediatrics / communication skills · medium · 8 minutes

Candidate brief

You are an FY2 doctor in the emergency department. Poppy Ellis, 2 years old, was brought in by ambulance an hour ago after her first febrile seizure. The seizure lasted about 2 minutes at home; she has recovered fully and is now playing. Her temperature was 38.9 °C; examination and observations are now normal and a viral upper respiratory infection is the likely cause. Urine has been sent; no other investigations are indicated. Her mother, Mrs Katie Ellis, is in the cubicle with her. She is tearful and says: "She just went stiff and started shaking — I thought she was dying. What WAS that? Is it epilepsy? Will it happen again?" Poppy is ready for discharge. Please explain what happened and complete the discharge discussion.

What examiners look for

The febrile-seizure discharge is a parent-education consultation disguised as a discharge. The child is already well; the patient for the last ten minutes is the mother's memory of the rug — and untreated, that memory becomes hypervigilance at every future sniffle. Explanation IS the treatment here. Learn the sentences that carry weight: "It was the fever, not her brain." "You could not have prevented it — fever medicine does not stop these." "One in three children have another; it will look like this, it will stop like this, and here is your plan." Each removes a specific terror: epilepsy, guilt, and the unknown. Simple versus complex is the classification that drives everything — duration, focality, recurrence in 24 hours, recovery. Get those four facts in every febrile-seizure history (from the parent, the crew, anyone who saw it) before you pronounce, because "simple" is a conclusion, not a default. First aid must be rehearsed, not recited: side, time, nothing in the mouth, five minutes means 999. Ask her to say it back. Parents who can recite the plan in the cubicle can perform it on the rug at 2 a.m.; parents who were handed a leaflet and a wave have been given paper, not a plan. And note what NOT to do: no routine EEG, bloods or scans after a simple febrile seizure with a found source and a recovered child. Unnecessary tests tell a mother the doctors are secretly worried; honest explanation tells her they are not.

Guideline references

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