Facts about Febrile Seizures

What are febrile seizures?


Febrile seizures are convulsions brought on by fever in infants or small children. 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. Most febrile seizures last a minute or two, although some can be as brief as a few seconds while others last for more than 15 minutes.


The majority of children with febrile seizures have rectal temperatures greater than 1020 F. Most febrile seizures occur during the first day of a child's fever. Children prone to febrile seizures are not considered to have epilepsy, since epilepsy is characterized by recurrent seizures that are not triggered by fever.


How common are febrile seizures?


Approximately one in every 25 children will have at least one febrile seizure, and more than one-third of these children will have additional febrile seizures before they outgrow the tendency to have them. Febrile seizures usually occur in children between the ages of 6 months and 5 years and are particularly common in toddlers. Children rarely develop their first febrile seizure before the age of 6 months or after 3 years of age. The older a child is when the first febrile seizure occurs, the less likely that child is to have more.


What makes a child prone to recurrent febrile seizures?


A few factors appear to boost a child's risk of having recurrent febrile seizures, including young age (less than 15 months) during the first seizure, frequent fevers, and having immediate family members with a history of febrile seizures. If the seizure occurs soon after fever has begun or when the temperature is relatively low, the risk of recurrence is higher.


Are febrile seizures harmful?


Although they can be frightening to parents, the vast majority of febrile seizures are short and harmless. During a seizure, there is a small chance that the child may be injured by falling or may choke from food or saliva in the mouth. Using proper first aid for seizures can help avoid these hazards.


There is no evidence that short 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 don't have seizures. Even when seizures are very long (more than 1 hour), most children recover completely, but a few might be at risk of subsequent seizures without fever (epilepsy).


In other words, between 95 and 98 percent of children who experience febrile seizures do not go on to develop epilepsy. However, although the absolute risk remains small, some groups of children--including those with cerebral palsy, delayed development, or other neurological abnormalities--have an increased risk of developing epilepsy. The type of febrile seizure also matters; children who have prolonged febrile seizures (particularly lasting more than an hour) or seizures that affect only part of the body, or that recur within 24 hours, are at a somewhat higher risk. Among children who don't have any of these risk factors, only one in 100 develops epilepsy after a febrile seizure.


What should be done for a child having a febrile seizure?


Seizures are frightening, but it is important that parents and caregivers stay calm and carefully observe the child. To prevent accidental injury, the child should be placed on a protected surface such as the floor or ground. The child should not be held or restrained during a convulsion. To prevent choking, the child should be placed on his or her side or stomach. When possible, gently remove any objects from the child's mouth. Never place anything in the child's mouth during a convulsion. Objects placed in the mouth can be broken and obstruct the child's airway. Look at your watch when the seizure starts. If the seizure lasts 10 minutes, the child should be taken immediately to the nearest medical facility. If not then once the seizure ends, the child should be taken to his or her doctor to check for the source of the fever.


How are febrile seizures diagnosed and treated?


Before diagnosing febrile seizures in infants and children, doctors sometimes perform tests to be sure that seizures are not caused by something other than simply the fever itself. For example, if your doctor suspects the child has meningitis (an infection of the membranes surrounding the brain), a spinal tap may be needed to check for signs of the infection in the cerebrospinal fluid. If there has been severe diarrhea or vomiting, dehydration could be responsible for seizures. Also, doctors often perform other tests such as examining the blood and urine to pinpoint the cause of the child's fever.


A child who has a febrile seizure usually doesn't need to be hospitalized. If the seizure is prolonged or is accompanied by a serious infection, or if the source of the infection cannot be determined, your doctor may recommend that the child be hospitalized for observation.


How are febrile seizures prevented?


If a child has a fever most parents will use fever-lowering drugs such as acetominophen or ibuprofen to make the child more comfortable, although there are no studies that prove that this will reduce the risk of a seizure.


Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures.


Children especially prone to febrile seizures may be treated with the drug diazepam orally or rectally, whenever they have fever. The majority of children with febrile seizures do not need to be treated with medication, but in some cases a doctor may decide that medicine given only while the child has a fever may be the best alternative. This medication may lower the risk of having another febrile seizure. It is usually well tolerated, although it occasionally can cause drowsiness, a lack of coordination, or hyperactivity. Children vary widely in their susceptibility to such side effects.


In addition, some children are prone to having very long (lasting an hour or more) febrile seizures. When a child has had a long febrile seizure, subsequent ones might also be long. Because very long febrile convulsions are associated with increased risk of developing epilepsy, some doctors will suggest the child be treated with a rectal form of the drug diazepam to stop the seizure and prevent it from becoming long. The parents of a child who had a very long febrile seizure may wish to consult their doctor about this possibility.



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