Introduction - Febrile Seizures:
Febrile seizures, also known as febrile convulsions or fits, are episodes in which a child experiences seizures in association with a fever. While febrile seizures may appear frightening, it is important to know that they are unlikely to harm your child or cause any long-term effects.
In this article, we will explore the causes, clinical features, and management of febrile seizures as well as answer commonly asked questions.
Overview:
Febrile seizures most commonly occur in children aged 6 months to 6 years, with a fever >38°C. They are relatively common, affecting 2 to 5 percent of healthy children [1], with a peak incidence between 12 and 18 months. Most children experience febrile seizures on the first day of illness, and in some cases, it is the initial manifestation of their illness.
Causes:
- Febrile seizures are believed to be related to the vulnerability of the developing brain to the effects of fever in combination with an underlying genetic susceptibility.
- A family history of febrile seizures is reported in approximately 15-20% of cases.
- Most febrile seizures are caused by viruses [2].
Common viruses known to cause febrile seizures [3] include:
- Human herpesvirus 6 (HHV-6)
- Influenza
- Adenovirus
- Parainfluenza
- Respiratory syncytial virus (RSV)
- Rotavirus
Clinical features:
During a febrile seizure, your child may exhibit some of the following clinical features:
- Lose consciousness or stare unresponsively.
- Become stiff or floppy.
- Experience twitching or jerking movements of the arms and legs. Less commonly, a child might become rigid or have twitches localised to one limb or one side of the body.
- Eye rolling, so only the whites of their eyes are visible.
- Experience involuntary urination.
- Foaming at the mouth.
- Shallow breathing or altered breathing.
- Show facial discoloration, with their face turning red, pale, or blue during the seizure.
- Following the seizure, your child may feel sleepy, irritable, or confused.
Most febrile seizures last a minute or two and resolve spontaneously even though these few minutes feel like eternity.
Caution: Viewer Discretion Advised
Witness a real-life example of a 22-month-old toddler experiencing a simple febrile seizure. Special thanks to Tara Price for sharing this video of her son and contributing to raising awareness.
Classification:
Febrile seizures are divided into two categories, simple or complex, based on their clinical features:
Simple Febrile Seizures: These are the most common type, accounting for 60-70% of febrile seizures [4]. In simple febrile seizures, the seizure activity is generalized, affecting the entire body. These seizures last less than 15 minutes and do not recur within a 24-hour period.
Complex Febrile Seizures: This category accounts for approximately 30-40% of all febrile seizures [4]. They are considered complex when they are focal, affecting only one part or one side of the body, when they last longer than 15 minutes or when they occur more than once within a 24-hour period.
Steps to Take During a Febrile Seizure:
- Stay calm and don't panic.
- Time, how long the seizure lasts.
- Place the child on a protected surface, to prevent injury and remove any dangerous objects that are nearby.
- Roll your child onto their side. This will protect their air way in an event of vomiting.
- If possible, place something soft under your child's head to stop their head from hitting the floor or protect their head with your hands.
- If the seizure lasts longer than 5 minutes call an ambulance on 000.
- If your child is having trouble breathing, gently lift their chin. If your child is not breathing at all, proceed to administer mouth-to-mouth resuscitation.
- Carefully observe the seizure; this will aid in describing the details to your health provider. If possible, recording a video of the seizure would be highly beneficial.
DO NOT:
- Restrain your child during a convulsion.
- Put anything in their mouth, including your fingers. Your child will not choke or swallow their tongue.
- Put a child who is convulsing in a bath.
When should you see a doctor?
It's recommended that all children be seen by a doctor after experiencing a febrile seizure. The doctor will confirm whether the convulsion was indeed caused by a fever and will also investigate the underlying cause of the fever. This process will include a thorough examination of your child, potentially accompanied by other tests.
Call 000 for an ambulance if:
- You're feeling worried.
- It's your child's first seizure.
- The seizure lasts longer than 5 minutes.
- Your child has repeated seizures.
- You suspect your child has inhaled food or vomit.
- Your child's breathing doesn't return to normal shortly after the seizure, or if your child remains blue around the lips.
- You are uncertain about your child's safety and normal recovery following the seizure.
If the seizure lasts longer than 5 minutes, medical providers will administer medication to stop the seizure.
Emergency Department Visit: What to Expect for Your Child
When your child is seen in the Emergency Department, the course of care will vary based on their appearance, the type of febrile seizure they've experienced, and the protocols followed by your local hospital.
For simple febrile seizures (as described earlier), where children seem well, a comprehensive examination by a doctor will take place to determine the cause of the fever.
Generally, further investigations aren't necessary. However, if needed, your doctor might suggest additional assessments like blood tests, urine tests, chest X-rays, and viral or bacterial swabs to accurately determine the cause of the fever. Following a period of careful observation, your child will likely be discharged to return home.
On the other hand, for children encountering complex febrile seizures (as described earlier), more extensive evaluation will be required. This will include blood tests and, depending on the situation, your doctor could recommend a lumbar puncture to rule out meningitis, or they might order brain imaging or an EEG to explore other underlying conditions. In these instances, an extended period of monitoring within the hospital will be essential.
Care at home:
In most cases, you can care for your child at home once a doctor has evaluated them for a febrile seizure.
- Your child might be a bit irritable for a day or two.
- If your child is feeling uncomfortable, you can provide them with paracetamol or Ibuprofen to help ease their discomfort. It's important to note that regular paracetamol or ibuprofen does not prevent further febrile convulsions [5,6,7].
- Put your child to sleep at the usual time, in his or her own bed. Don't worry about whether you will hear a seizure; a bed or cot is a safe place for a seizure.
Frequently Asked Questions (FAQ):
Can I prevent my child from having a febrile seizure by administering Paracetamol or Ibuprofen?
No. While these medicines might help reduce fever, a febrile seizure can still occur in spite of them. If your child is susceptible to a febrile seizure, it will occur regardless. Paracetamol or Ibuprofen will not prevent it [5,6,7].
Do febrile seizures cause brain damage?
No. Although febrile seizures can appear alarming, they don't result in brain damage.
If my child had a febrile seizure, will it happen again?
About one in three children will experience additional febrile seizures with subsequent febrile illnesses. Your child will outgrow the tendency to have febrile seizures by the time they are about 6 years old.
Does a febrile seizure in my child indicate a serious infection?
Having a febrile seizure doesn't suggest a greater likelihood of a severe infection compared to any other child experiencing a fever. Generally, viral infections are the main underlying cause.
Why is my child sleepy after the seizure?
Your child will become tired after the seizure and will need time to rest and recover. If your child remains drowsy or difficult to wake after sleep, you should seek urgent medical attention.
If my child has a febrile seizure, does that mean they have epilepsy?
No. Febrile seizures are seizures that occur only with a fever. Children with epilepsy have repeated seizures without fever. Even if your child has many febrile seizures, it still does not mean they have epilepsy. Children who have simple febrile seizures do not have an increased risk of epilepsy.
Can a febrile seizure occur without a fever?
Occasionally, a child may not have a fever at the time of the seizure but will develop one a few hours later. Hence, it's possible.
Is there medication to assist with recurrent febrile seizures?
Usually, medications aren't prescribed due to potential side effects outweighing the benefits. However, in cases of frequent or prolonged seizures, a doctor might recommend medicine for use during a seizure, like buccal Midazolam, or a medication taken during fevers to prevent seizures, such as Clobazam.
Summary:
- Approximately 2-5% of healthy children will experience a febrile seizure at some point, typically occurring between the ages of six months and six years.
- Although witnessing a febrile seizure in your child can be frightening, it's important to remember that these seizures are not typically harmful and rarely result in long-term effects.
- During a seizure, remain calm and try not to panic. Check the time and place your child on their side. Do not put your child in a bath, restrain them, or put anything in their mouth.
- If the seizure lasts more than five minutes, call an ambulance.
- All children should be seen by a doctor after experiencing a febrile seizure.
- Giving regular Panadol or Nurofen will not prevent a febrile seizure from occurring.
Written by Dr Samuel Heitner
Bibliography:
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- Patel N, Ram D, Swiderska N, Mewasingh LD, Newton RW, Offringa M. Febrile seizures. BMJ. 2015 Aug 18;351:h4240.
- Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, Rantala H. Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial. Arch Pediatr Adolesc Med. 2009 Sep;163(9):799-804.
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https://www.uptodate.com/contents/clinical-features-and-evaluation-of-febrile-seizures
https://www.schn.health.nsw.gov.au/files/factsheets/fever_-_febrile_convulsions-en.pdf
https://www.rch.org.au/kidsinfo/fact_sheets/Febrile_seizures/
https://www.ninds.nih.gov/health-information/disorders/febrile-seizures