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                                 Febrile seizures


Probably one of the scariest things a parent can witness regarding their child is a seizure.

Seizures that result from a fever (febrile seizures) are common occurrences in children so it is important for concerned parents to sort out fact from fiction.

What is a febrile seizure?

• Febrile seizures are convulsions brought on by a high fever in infants and small children.
  
  
• Febrile seizures are very common, occurring in about 2 - 5% of all children.
  
  
• They are most common in children between the ages of 6 months and 5 years.
  
  
• Most febrile seizures occur during the first day of a childs fever and often the seizure is the first sign of illness.
  
  
• The majority of children with febrile seizures have rectal temperatures greater than 102 degrees F.
  
  
• Although a child has both a fever and a seizure, it is sometimes possible that a child has something more serious going on, such as meningitis, in which case the fever did not trigger the seizure.
  
  

What does a febrile seizure look like?

• During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. 
  
  
• Less commonly, the child becomes rigid or has twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only.
  
  

How long can febrile seizures they last?

• Most febrile seizures last a minute or two, although some can be as brief as a few seconds while others last for more than 10 minutes.
  
  
• Febrile seizures can either be simple or complex.

o  Simple febrile seizures are brief (< 15 minutes), only occur once in the same illness, and involve more than just one specific part of the body (generalized).  Simple febrile seizures are the most common type.

o  Complex febrile seizures are long (>15 minutes), may occur more than once in the same illness, and may involve just one specific part of the body (e.g., right arm and right leg).

If your child is having a febrile seizure?

1.Stay calm and carefully watch your child. 

2.Place your child on a flat surface such as the floor or ground. Your child should not be held or restrained during a seizure.

3.To prevent choking, your child should be placed on their side.

4.Don’t put anything in your childs mouth during a seizure to avoid blockage of their airway.

5.Once the above steps are taken, call to inform your pediatrician who may advise you to come into the office for evaluation or to call 911 for immediate transport of your child to the nearest medical facility. 

What will doctors do to evaluate my child after a febrile seizure?

• After having a febrile seizure, children should be evaluated by a doctor to be sure that the seizure is not caused by something other than simply the fever itself.
  
  
• As with any evaluation, taking a history and completing a thorough physical examination is very important in locating a possible source of infection (e.g., ear infection) and developing a care plan for your child.
  
  
• For most children over 12 to 18 months of age no further testing or interventions will need to be done if the child appears normal and does not have signs of meningitis.
  
  
• It can be difficult to recognize serious infections (e.g., meningitis, urinary tract infection) in children under 12 to 18 months of age so certain tests may need to be done, especially if a specific source of infection is not found or your child is not acting normal on examination.

                    o  These tests may require the collection of blood, urine,
                         and/or spinal fluid (the fluid that bathes the brain and
                         spinal cord). Spinal fluid collection requires a lumbar
                         puncture, or spinal tap, and is tested for meningitis.

• The American Academy of Pediatrics recommends that a lumbar puncture be strongly considered in children less than 12 months of age after having a febrile seizure.
  
  
• A head CAT scan or head MRI is not routinely performed on children after a simple febrile seizure.
  
  
• A child who has a febrile seizure usually doesnt need to be hospitalized. If the seizure is prolonged or is accompanied by a serious infection, the doctor may recommend that your child be hospitalized for observation.
  
  
  

What is the treatment for febrile seizures?

• Most children with febrile seizures do not need treatment, even if they have more than one febrile seizure.
  
  
• Diazepam (Valium) can be given orally or rectally, whenever these children have a fever, although it is unknown how effective this approach is with preventing a febrile seizure.  The drug can also be given during a febrile seizure to possibly prevent or shorten the length of a seizure.
  
  
• Children who have repeated, complex febrile seizures or have status epilepticus (i.e. seizure disorder) are usually the children who may need anticonvulsant therapy.

Will a febrile seizure cause brain damage in my child?

• Fortunately, febrile seizures usually cause no long-term health problems. 
  
  
• There is no evidence that febrile seizures cause brain damage. Large studies have found that children with febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who do not have seizures.

Will my child be at increased risk for more seizures after having a febrile seizure?

• About 1/3 of children who have a febrile seizure go on later to have another one.
  
  
• A childs risk of having recurrent febrile seizures is higher if one or more of the following factors are present:

                  o  young age (less than 15 months) during the first seizure
                  o  if the first seizure was a complex febrile seizure
                  o  having an immediate family member with a history of febrile 
                      seizures

• Fortunately, most children outgrow having febrile seizures by the time they are 5 years old.
  
  
• Children who have a simple febrile seizure have a very small risk (1 – 2 percent) of later developing a seizure disorder or epilepsy (repeated seizures without fever).

                 o  The risk is higher, up to 10%, if the child had a complex
                      febrile seizure, has other family members with epilepsy, or if
                      they have other neurological problems.



How can I prevent my child from having a febrile seizure?

• Giving a fever reducer, such as Tylenol or Motrin, at the first sign of a fever is often recommended, although there are no studies that prove that this will reduce the risk of a seizure.
  
  
• Some children who have many febrile seizures may be treated with the drug diazepam (Valium) at the first sign of fever, but this should first be discussed with your doctor or a pediatric neurologist.
  
  
• Prolonged daily use of oral anticonvulsants, such as valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing these types of seizures.