The rate of recurrence of febrile seizures and the factors predictive of a recurrence were prospectively examined in a cohort of 98 Saudi children who presented consecutively with their first febrile seizure at the pediatric emergency department of the King Khalid University Hospital, Riyadh, Saudi Arabia. Children with prior afebrile seizures or evidence of a neurodevelopmental deficit were excluded. The median age was 15 months (range, 4 to 60 months). Of the 98 children, 72 had simple and 26 had complex initial febrile seizures. In a follow-up of 3 to 6 years (mean, 49 months), 26% of the 98 untreated children had at least one recurrence and only 8% had more than three recurrent febrile seizures; 30% of first recurrences took place within 3 months, 60% within 6 months, 72% within 12 months, and 96% within 24 months of the onset. Four major risk factors for recurrent febrile seizures were identified: early age at onset (< 12 months), first-degree consanguinity of parents, epilepsy in a first-degree relative, and complex initial febrile seizure. Gender, family history of febrile seizures, and degree of fever were not related to recurrence.