Lumbar puncture should be considered in children aged 12-18 months, because clinical signs and symptoms of bacterial meningitis may be subtle in this age group. In children older than 18 months, the decision to perform lumbar puncture rests on the clinical suspicion of meningitis. Continuous therapy with phenobarbital or valproate decreases the occurrence of subsequent febrile seizures. Both therapies confer significant risks and potential adverse effects, whereas additional simple febrile seizures have no proven risk. These medications are not recommended, since the potential benefits do not outweigh the potential risks.
Oral diazepam can reduce the risk of subsequent febrile seizures.
Because it is intermittent, this therapy probably has the fewest adverse effects. If preventing subsequent febrile seizures is essential, this would be the treatment of choice. Although it does not prevent simple febrile seizures, antipyretic therapy is desirable for other reasons. No activity restrictions are necessary. In unusual circumstances, oral diazepam can be given with each fever.