Febrile Seizures and School Performance

Importance Febrile seizures affect 2% to 5% of children and are associated with substantial parental distress and concerns about the child’s long-term cognitive development. Objective To examine the association between febrile seizures and school performance as measured by standardized tests. Design, Setting, and Participants This is a nationwide register-based cohort study of children born in Denmark (1997-2009) who participated in the Danish National School Test Program from 2010 to 2019 (ages 7-17 years). Data were analyzed from March 2025 to June 2026. Exposure Children with hospital contacts for febrile seizures identified through the Danish National Patient Register. Main Outcomes and Measures The primary outcome was performance on norm-based standardized reading (grades 2, 4, 6, and 8) and mathematics (grades 3, 6, and 8) tests, scored as national percentiles (scale, 1-100). Adjusted differences in mean scores were estimated using linear regression. Results Of 672 119 children (344 664 boys [51.3%]; 327 455 girls [48.7%]) participating in testing, 26 173 (3.9%) with a history of febrile seizures were identified. Combined test scores were marginally lower in children who experienced febrile seizures (108 265 tests; mean score, 54.7 points; 95% CI, 54.6 to 54.9 points) than in those who did not (2 684 629 tests; mean score, 55.8 points; 95% CI, 55.7 to 55.8 points), corresponding to an adjusted mean difference of −0.4 point (95% CI, −0.7 to −0.2 point). The difference was slightly more pronounced in girls (−0.7 point; 95% CI, −1.1 to −0.3 point) than in boys (−0.2 point; 95% CI, −0.5 to 0.2 point). School test performance declined with increasing number of febrile seizure–related hospital contacts, from −0.1 point (95% CI, −0.4 to 0.2 point) for those with 1 contact to −5.8 points (95% CI, −9.1 to −2.4 points) for those with 7 or more contacts. Epilepsy occurred more frequently in children with a history of febrile seizures (838 of 26 173 children [3.2%]) than in those without (5600 of 645 946 children [0.9%]), and was associated with substantially larger test score differences (children with febrile seizures and epilepsy vs children with neither, −7.2 points; 95% CI, −8.7 to −5.7 points). Test scores were also marginally lower in children with febrile seizures compared with their unaffected siblings (−0.6 point; 95% CI, −1.0 to −0.3 point). Conclusions and Relevance In this cohort study of more than 26 000 children with febrile seizures, school performance was generally comparable to that of their peers, but a smaller subset (eg, children who had recurrent hospital contacts with febrile seizures or who developed epilepsy) were at risk of poorer academic outcomes and may benefit from additional educational support.