and family factors The consequences of further seizures must be balanced against the potential side effects of the anticonvulsant agents Treatment is seldom started after a single, uncomplicated nonfebrile seizure because most such patients will not experience a seizure recurrence It is preferable to make long-term treatment decisions in conjunction with the provider who will be responsible for ongoing follow-up of the patient, either a neurologist or the child’s primary care physician Sometimes, it may be necessary to begin prophylactic treatment in the ED, pending a more complete outpatient evaluation Disposition Hospital admission is generally required for children who have had a prolonged seizure requiring acute treatment with anticonvulsant medication With the exception of very young infants, other children, even those with a first-time seizure, can generally be followed as outpatients if they appear well after the seizure, follow-up can be ensured, and the parents are comfortable with home management Seizure first aid should be explained to the family before discharge Some practitioners may choose to prescribe rectal diazepam as a rescue medication until a decision is made about instituting chronic anticonvulsant therapy After a simple febrile seizure, hospitalization is seldom necessary, and children may be followed by their primary physician Some useful information can be given to parents after a first febrile seizure First, they should be informed of the benign nature of the convulsions and the lack of evidence that they cause any type of neurologic injury unless they are prolonged Approximately one-third of children with a first febrile seizure will have another one Of recurrences, 75% occur within year, and they are uncommon beyond years; fewer than 10% of children with febrile seizures have more than three The recurrence rate is lower if the seizures begin after the first year of life, and the risk is also reduced in children with higher temperature and longer duration of fever before the initial febrile seizure For example, the recurrence risk is about 35% when the first seizure occurs at a temperature of 38.5°C (101.3°F), compared with a risk of 13% with a temperature of 40°C (104°F) Having a complex first febrile seizure (even febrile SE) does not increase the risk of recurrence, nor does it increase the chance that a recurrent seizure, if it occurs, will be complex Many parents are concerned that febrile seizures will lead to future epilepsy A child who has had a febrile seizure but no other risk factors for epilepsy may have a slightly increased risk of future nonfebrile seizures, but the magnitude of this increase is still extremely small: 1% to 2% lifetime risk versus a 0.5% to 1%