What Are The Specific Risk Factors Associated With Febrile Seizures In Children Under 5 Years Old In Urban Pediatric Populations ? : A Comprehensive Systematic Review
Keywords:
Febrile seizures, risk factors, urban pediatric population, iron deficiency anemia, breastfeeding, genetic mutations, prophylactic treatment, parental educationAbstract
Introduction: Febrile seizures (FS) are the most common seizure type in children under five years, especially in urban pediatric populations. These seizures occur with fever without intracranial infection and pose significant clinical challenges due to their acute onset and recurrence risk. Understanding FS risk factors is essential for early identification and prevention. Methods: A systematic review following PRISMA 2020 guidelines was conducted, including 40 studies published since 2015. Studies focused on children aged 0-5 years in urban settings, examining demographic, clinical, genetic, and environmental risk factors for FS. Data extraction covered study design, population characteristics, risk factors, outcomes, and interventions. Boolean MeSH keywords related to pediatric populations, feeding methods, treatments, and FS outcomes guided database searches. Results: Younger age (6-60 months) and family history of febrile seizures showed strong and moderate-to-strong associations with FS risk, respectively. Iron deficiency anemia was prevalent in 38% of FS cases and strongly correlated with seizure occurrence. Other moderate risk factors included low serum zinc and calcium, infections such as HHV-6, and genetic mutations (notably SCN1A). Formula feeding was linked to higher FS occurrence, while exclusive breastfeeding showed a protective effect. Prophylactic treatments like diazepam and sodium valproate reduced recurrence, though safety profiles varied. Nursing and parental education improved symptom management and anxiety. Discussion: FS etiology is multifactorial, involving demographic, clinical, genetic, and environmental factors that often interact, compounding risk. Age-specific strategies—such as genetic screening in infants and iron supplementation in toddlers—are recommended. Urban environmental factors and healthcare disparities further influence FS risk and management. Conclusion: Febrile seizures in urban children under five result from complex, interacting risk factors. Prevention and management require integrated, age-tailored approaches including nutritional support, infection control, prophylactic medication, breastfeeding promotion, and education. Continued research and guideline adherence are vital to improve outcomes.References
A. Fayyazi, A. Khajeh, and Ashraf Baghbani. “Comparison of Effectiveness of Topiramate and Diazepam in Preventing Risk of Recurrent Febrile Seizure in Children Under Age of 2 Years.” Iranian Journal of Child Neurology, 2018.
A. Fayyazi, N. Pezeshki, F. Hosseini, Reyhane Eslamian, and Farzaneh Esnaashari. “Effectiveness of Prophy- laxis Treatment in the Acute Febrile Stage of Febrile Seizure in Children Under Five Years Old.” Iranian Journal of Child Neurology, 2022.
A. O. von Saint Andre-von Arnim, R. Kumar, J. Clark, B. Wilfond, Q. Nguyen, Daniel Munyambu Mutonga, J. Zimmerman, A. Oron, and J. Walson. “Family-Assisted Severity of Illness Monitoring for Hospital- ized Children in Low-Resource Settings—A Two-Arm Interventional Feasibility Study.” Frontiers in Pediatrics, 2021.
Andrea L. Conroy, Andrea L. Conroy, M. Hawkes, Kyla Hayford, Kyla Hayford, L. Hermann, Chloe R. McDonald, et al. “Methemoglobin and Nitric Oxide Therapy in Ugandan Children Hospitalized for Febrile Illness: Results from a Prospective Cohort Study and Randomized Double-Blind Placebo-Controlled Trial.” BMC Pediatrics, 2016.
B. Gomez, Amaia Fernandez-Uria, J. Benito, Ainara Lejarzegi, and S. Mintegi. “Impact of the Step-by-Step on Febrile Infants.” Archives of Disease in Childhood, 2021.
Bin Li, Youjia Wu, Qingjuan He, Hui Zhou, and Jin Cai. “The Effect of Complicated Febrile Convulsion on Hippocampal Function and Its Antiepileptic Treatment Significance.” Translational Pediatrics, 2021.
Corrie E. McDaniel, Ellen Kerns, Brittany Jennings, Sloane Magee, Eric Biondi, Ricky Flores, and Paul L Aronson. “Improving Guideline-Concordant Care for Febrile Infants Through a Quality Improvement Initiative.” Pediatrics, 2024.
D. Lanzlinger. “Reduction in Recurrence of Febrile Seizures with Paracetamol Use.” Journal of Paediatrics and Child Health, 2019.
E. Walter, Christoph P. Hornik, L. Grohskopf, C. Mcgee, Christopher A. Todd, Oidda I. Museru, L. Har- rington, and K. Broder. “The Effect of Antipyretics on Immune Response and Fever Following Receipt of Inactivated Influenza Vaccine in Young Children.” Vaccine, 2017.
F. Frascari, I. Dreyfus, Y. Chaix, and C. Tison-Chambellan. “Efficacy of an Interventional Educational Programme in Mitigating Post-Traumatic Stress in Parents Who Have Witnessed a Febrile Seizure: A Pilot Before-and-After Study.” BMJ Paediatrics Open, 2017.
Gretchen L. Birbeck, Karl B. Seydel, Suzanna Mwanza, Derby Tembo, Moses B Chilombe, Arthur Watts, Ifu- nanya Ume-Ezeoke, et al. “Acetaminophen and Ibuprofen in Pediatric Central Nervous System Malaria: A Randomized Clinical Trial.” JAMA Neurology, 2024
“Highlights from the Literature.” Archives of Disease in Childhood, 2018.
I. Sharawat, P. Panda, Vinod Kumar, A. Ramachandran, Sanjot Bhardwaj, V. Murugan, A. Pradhan, Rajkali Rajendiran, and N. Bhat. “Effectiveness of Prophylactic Iron Supplementation in the Reduction of Recurrence of Febrile Seizures in Children: A Prospective Study with Comparison with Historical Controls.” Journal of Neurosciences in Rural Practice, 2022
J. Merino. “Spotlight on the July 21 Issue.” Neurology, 2020.
J. Min, Anup D. Patel, Peter A. Glynn, M. Otgonsuren, Babitha Harridas, and Z. Grinspan. “Evaluation of a Care Management Program for Pediatric Epilepsy Patients.” Journal of Child Neurology, 2020.
J. Na, J. Cha, Jin-Hwa Moon, Heekyung Lee, Yong Joo Kim, and Yongil Cho. “Protective Effect of Breastfeeding Against Febrile Seizure: A Nationwide Study in Korea.” Pediatric Neurology, 2022.
J. Yeom, Youngsoo Kim, R. Kim, J. Park, J. Seo, E. Park, Jae-Young Lim, Chan-Hoo Park, H. Woo, and H. Youn. “Impact of Rotavirus Vaccine Introduction on Rotavirus-Associated Seizures and a Related Possible Mechanism.” Journal of Child Neurology, 2015.
Jemima Grace D Fronda, Mel Michel G Villaluz, and Cristina M. Cruz-Urbi. “Oral Loading of Phenobarbital to Achieve Therapeutic Effects in Pediatric Patients with Acute Repetitive Seizures.” Annals of Child Neurology, 2022.
L. Tang, and Jie-ru Chen. “The Predictive Value of Hemocytometry Based on Peripheral Platelet-Related Parameters in Identifying the Causes of Febrile Seizures.” Journal of Inflammation Research, 2021.
Linyan Hu, Xiu-yu Shi, Hui Li, Meng-Na Zhang, Shu-Fang Ma, and L. Zou. “Intermittent Oral Levetiracetam Reduced Recurrence of Febrile Seizure Accompanied with Epileptiform Discharge: A Pilot Study.” Italian Journal of Pediatrics, 2018.
M. Ghazavi, J. Nasiri, O. Yaghini, and R. Soltani. “Oral Diazepam in Febrile Seizures Following Acellular Pertussis Vaccination.” Advanced Biomedical Research, 2019.
M. M. Houshmandi, A. Moayedi, M. Rahmati, A. Nazemi, Darioush Fakhrai, and S. Zare. “Human Herpes Virus Type 6 and Febrile Convulsion.” Iranian Journal of Child Neurology, 2015.
M. Salehiomran, S. Hoseini, and Ali Ghabeli Juibary. “Intermittent Diazepam Versus Continuous Pheno- barbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial.” Iranian Journal of Child Neurology, 2016.
M. van Stuijvenberg, J. Stam, C. Grüber, F. Mosca, S. Arslanoğlu, G. Chirico, C. Braegger, J. Riedler, G. Boehm, and P. Sauer. “Similar Occurrence of Febrile Episodes Reported in Non-Atopic Children at Three to Five Years of Age After Prebiotics Supplemented Infant Formula.” PLoS ONE, 2015.
Maria Punchak, Edith Mbabazi Kabachelor, Michael Ogwal, E. Nalule, J. Nalwoga, P. Ssenyonga, J. Mugamba, et al. “The Incidence of Postoperative Seizures Following Treatment of Postinfectious Hy- drocephalus in Ugandan Infants: A Post Hoc Comparison of Endoscopic Treatment Vs Shunt Placement in a Randomized Controlled Trial.” Neurosurgery, 2019.
Masahiro Nishiyama, H. Nagase, Kazumi Tomioka, Tsukasa Tanaka, H. Yamaguchi, Yusuke Ishida, Daisaku Toyoshima, et al. “Fosphenytoin Vs. Continuous Midazolam for Pediatric Febrile Status Epilepticus.” Brain & Development (Tokyo. 1979), 2018.
Mohammad Reza Navaeifar, A. Abbaskhanian, and Akram Farmanbarborji. “Relation Between Febrile Seizure Recurrence and Hyponatremia in Children: A Single-Center Trial.” Journal of Pediatric Neuro- sciences, 2020.
Nalin Chaudhary, R. Narayana, and S. Chaudhary. “Reduction of Febrile Seizure Recurrence Comparative Efficacy of Intermittent Oral Levetiracetam Vs Clobazam (P3.239).” Neurology, 2016.
R. Fallah, Saeideh Sabbaghzadegan, S. A. Karbasi, and F. Binesh. “Efficacy of Zinc Sulfate Supplement on Febrile Seizure Recurrence Prevention in Children with Normal Serum Zinc Level: A Randomised Clinical Trial.” Nutrition (Burbank, Los Angeles County, Calif.), 2015.
R. Renda, and Y. Gürer. “Evaluation of Patients With Febrile Seizure: Risk Factors, Reccurence, Treatment and Prognosis.” Pediatric Emergency Care, 2017.
Rongrong Chen, Shuangshuang Li, Xiaokang Wang, Jinjun Zhou, Yi Lu, and Aijian Kang. “Analysis of Cytokines and Trace Elements in Children with Febrile Seizures.” Translational Pediatrics, 2020.
S. Rice, R. M. Müller, S. Jeschke, B. Herziger, T. Bertsche, M. Neininger, and A. Bertsche. “Febrile Seizures: Perceptions and Knowledge of Parents of Affected and Unaffected Children.” European Journal of Pediatrics, 2021.
S. Yarosz, William Parker, A. Gibson, and Anup D. Patel. “IHI ID 15 Decreasing Low-Dose, Rescue Seizure Medication Prescriptions in Neurology Clinic.” Abstracts, 2018.
Shan Xiao. “Application Effect of Comprehensive Nursing Intervention in Nursing Children with Febrile Convulsion,” 2020
Shazia Khan, A. Salahuddin, and Mohammad Noman. “ASSOCIATION BETWEEN IRON DEFICIENCY ANEMIA AND FEBRILE SEIZURES,” 2016.
Shinya Murata, K. Okasora, T. Tanabe, Motoko Ogino, Satoshi Yamazaki, Chizu Oba, Kohsuke Syabana, et al. “Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode.” Pediatrics, 2018.
Wei He. “Comparative Study on the Efficacy and Safety of Low-Dose Sodium Valproate Vs. Diazepam in the Prevention and Treatment of Pediatric Febrile Convulsion.” Translational Pediatrics, 2020.
Xiaoli Shao, Jiani Hu, Ying-shui Yao, D. Yu, and Zhefeng Yuan. “Risk Analysis of Vaccination in Children with Genetic Epilepsy Combined with Febrile Seizures Plus,” 2020.
Zaiyun Zhu, Liping Chen, and Kai Li. “Effect of Nursing Interventions Based on the Kano Model on Symptom Relief and Parental Psychological Behavior in Children with Febrile Seizures.” Frontiers in Psychology, 2023.
Zeinab hosseinrezaei, F. Ghaljaei, and F. Najafi. “Effect of Training on Understanding the Uncertainty and Anxiety of Mothers in Children with Febrile Seizure in a Hospital: A Quasi-Experimental Study,” 2021.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Mega Reliska, H. Mustarim (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
