Objective This study aimed to identify the risk factors associated with the recurrence of seizures during the acute phase of febrile seizures (FS) in children. Methods A retrospective analysis of FS patients treated in the emergency department from January to December 2021 were conducted. Those with recurrent seizures during the acute phase were categorized as the recurrent febrile seizures group (RFS), while those with non-recurrent FS, matched for age and gender at a ratio of 1:2, were designated as the non-recurrent febrile seizures group (NRFS). Demographic data, clinical characteristics of seizures, and laboratory findings were compared between the RFS and NRFS groups. Significant variables from univariate analysis were subsequently included in a multivariate logistic regression analysis to explore the determinants of seizure recurrence in the acute phase of FS. Results Among the 204 enrolled patients, 68 were in the RFS group and 136 in the NRFS group. The RFS group exhibited shorter intervals from fever onset to seizure, a younger age at the initial FS episode, lower body temperature at the time of seizure, and higher neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein (CRP) levels, all of which were statistically significant (P<0.05). Multivariate logistic regression analysis revealed that a positive family history of FS (OR=8.157, 95% CI: 2.773-23.989), younger age at the first FS episode (OR=0.960, 95% CI: 0.928-0.994), higher MLR (OR=6.608, 95% CI: 1.505-29.020), and elevated CRP (OR=1.108, 95% CI: 1.041-1.180) were significant predictors of seizure recurrence during the acute phase of FS. The predictive model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve, which was 0.871 (95% CI: 0.818-0.923), with a critical value of 0.30, yielding a sensitivity of 85.3% and a specificity of 76.5%. Conclusion A positive family history of FS, a younger age at the first FS episode, and elevated MLR and CRP levels are risk factors for the recurrence of seizures during the acute phase of FS in children. The use of logistic regression to develop a combined predictive factor offers a higher diagnostic value for identifying seizure recurrence in this phase.