Febrile Seizures: Frightening, but Generally Harmless
A febrile seizure can be a frightening event for a parent or caregiver to witness. One minute your child is playing normally and the next minute she's dropped to the ground and her tiny body is flailing in erratic convulsions.
Febrile (fever) seizures are generally brought on by a rapid increase in body temperature and occur mostly in children between the ages of six months and five years old. The child loses consciousness and begins to shake, usually moving limbs on both sides of the body. Less commonly, the child becomes stiff or has twitches in only a portion of the body, such as an arm or leg. Most seizures last only a minute or two, and afterward the child will usually fall into a very deep sleep, waking up in a short time and returning to normal.
While febrile seizures are common and usually benign, it is important to have your child examined by his or her pediatrician if one occurs. The doctor will want to determine the cause of the fever and provide the proper medication. The pediatrician will also want to evaluate the child to exclude more serious conditions, as well as to identify if your child is at increased risk for recurrent or prolonged febrile seizures. Approximately one-third of children who have febrile seizures will have another, but you can take some precautions to help eliminate the likelihood of another occurrence.
Can Seizures Be Prevented?
There is no conclusive test to determine whether your infant is at risk for seizures. Since they generally happen during a rapid upswing in body temperature, you may be unaware that your child even has a fever. Once a first seizure has occurred however, pediatricians advise parents to monitor the child's temperature when he/she seems to be coming down with something. Doctors caution against "fever phobia," but recommend that parents give their child a fever reducer whenever the temperature reaches 100.5 °F. They also suggest that parents notify any caregivers that the child has a problem with seizures.
Doctors sometimes treat severe or prolonged seizures with medication. Diazepam can be given orally or by an intravenous solution rectally. Its rapid absorption rate means that it can be used to abort an ongoing seizure or as prophylactic protection against seizures.
Simple and Complex Seizures
Most seizures are classified as "simple." The movements are generalized and the seizure lasts less than 15 minutes. Seizures classified as "complex" last longer, are localized to one side of the body, and may occur more than once within 24 hours. There is also a slightly increased risk of subsequent occurrences if your child experiences a complex seizure. If your child is less than one year old when she has her first seizure, she has a 50% chance of a recurrence.
The risk of another febrile seizure is also slightly higher if there is a family history of febrile seizures or if the fever wasn't very high when the first seizure occurred. Children who have their first seizure at the age of three or older have only a 20% risk of a recurrence.
A Connection Between Febrile Seizures and Epilepsy?
Approximately 2%-4% of children with febrile seizures develop ]]>epilepsy]]>, yet there is no evidence that short febrile seizures cause epilepsy. Still, medical arguments persist about prolonged febrile seizures and the development of temporal lobe epilepsy. The relationship appears to be very rare, and it is still under investigation. There is no way to determine if a child will develop temporal lobe epilepsy or whether any particular form of treatment is preventive.
Epilepsy is usually the primary focus of a medical practitioner examining a child with a first febrile seizure. Epilepsy is a risk for children who have complex febrile seizures, a family history of epilepsy, or neurological abnormalities. Many studies of children with epilepsy do indicate that approximately 15% of them have had febrile seizures. This, however, suggests that the febrile seizure tendency is a reflection of a child's seizure threshold, rather than an indication of a cause and effect relationship.
What to Do If Your Child Has a Febrile Seizure
If your child has a febrile seizure, the best advice may be the hardest: stay calm, keep track of the time, and observe your child carefully. While these things are probably the furthest from your mind when a seizure is ongoing, doing so will allow you to describe the details of the episode to your pediatrician. Here's what to do:
- Don't restrain any movements.
- Don't put anything in the child's mouth.
- Place the child on his or her side so he or she won't choke on saliva.
- Observe the child's chest and mouth for signs of breathing. If he or she is not breathing, call 911 immediately.
- Call 911 if the seizure lasts more than 10 minutes.
It is important to remember that febrile seizures are childhood events. Rest assured that there is no evidence that this type of seizures cause any damage to the brain. Large-scale studies have shown that children with febrile seizures have normal school development, and even in the case of a lengthy seizure of more than one hour, the child usually recovers completely.
Take heart in the fact that susceptibility to febrile seizures is a temporary situation. Manage your child's fever and take note of what happens if an additional seizure occurs. Follow your medical practitioner's advice and try to be an alert, but not overprotective, parent.
American Academy of Family Physicians
American Academy of Pediatrics
Barlow, WE, Davis, RL, Glasser, JW, et al. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rebella vaccine. N Engl J Med 2001; 345:656.
Fishman, MA. Febrile seizures. In: Principles and Practice of Pediatrics. 3rd ed, McMillan, JA, et al (Eds), JB Lippincott, Philadelphia, 1999, p. 1949.
Last reviewed March 2008 by ]]> Marcin Chwistek, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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