What is febrile seizures?
It is the most common type of convulsion seen among children It generally affects children between 6 months – 6 years and peak incidence occur between 12-24 months. However, it can rarely occur as early as one month of life as well. It can rarely continue to occur even after 6 years.
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How do you recognize febrile seizures?
They occur during a febrile illnessIn a majority, they occur during the first 24 hours of the febrile illness.
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What should you do when your child has a febrile seizure?
As explained above, DO NOT PANIC, STAY CALM Ensure child safety first.
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When should the child be taken to the hospital?
If this is the first episode of febrile seizure If the convulsion lasts more than 5 minutes
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What is febrile seizures?
- It is the most common type of convulsion seen among children
- It generally affects children between 6 months – 6 years and peak incidence occur between 12-24 months. However, it can rarely occur as early as one month of life as well. It can rarely continue to occur even after 6 years.
- It is a convulsion occurring during a febrile illness but which is not related to an infection affecting the brain. It is also not a seizure that occurs due to the alteration of the sugar or electrolyte status during a febrile illness.
- What causes febrile seizures is not the elevation of temperature. It is due to the alteration of the brain wave excitability by many different types of chemical substances released into the body during a febrile illness. These substances are called cytokines. They can alter the spontaneous firing of neuronal cells.
- Both boys and girls are equally affected with this condition.
- There is a strong tendency to inherit this condition. (positive family history)
How do you recognize febrile seizures?
- They occur during a febrile illness
- In a majority, they occur during the first 24 hours of the febrile illness.
- Sometimes the child may not have detectable fever at the time of convulsion but fever will then develop later.
- They are very obvious jerking episodes, often affecting all four limbs
- Usually child’s whole body (specially limbs) stiffens and then starts to shake (fitting)
- During the attack child may have eye rolling upwards, frothing, urinary or facial incontinence.
- Majority of these usually last less than five minutes
- Usually child does not manifest any other abnormal behaviour or symptoms during or after the seizure
What should you do when your child has a febrile seizure?
- As explained above, DO NOT PANIC, STAY CALM
- Ensure child safety first.
- Follow instructions given above on first aid management of a child with a seizure.
- Be with the child and observe the features of the seizure closely
- Observe the child’s physical and behaviour changes and remember in an order as it will be useful in the diagnosis.
- Do not try to shake or wake the child up
- Do not attempt to put any objects or fingers in to the child’s mouth.
- Do not give water or medications at the time of febrile convulsion.
- Let the child sleep after the convulsion.
- After any episode of febrile seizure, your child should be examined by a doctor to exclude underlying major illness. This can be done once the child recovers from the seizure.
When should the child be taken to the hospital?
- If this is the first episode of febrile seizure
- If the convulsion lasts more than 5 minutes
- If the child is less than 1 year of age
- If the child shows an unusual sleepiness with the illness, or if any change in child’s behaviour is noted
- In a majority of children, they experience only simple febrile seizures.These have
- No long term intellectual or behavioural adverse outcome
- No additional effect on their future related to education
- No additional risk of death
- No additional risk of epilepsy in future
- However they have a relatively high risk (30%) of developing a similar second episode. Some factors make the recurrence risk greater. These include having a positive family history of febrile seizures, having had experienced a complex febrile seizure, very young age (less than one year) at time of first febrile seizure, lower body temperature at time of the seizure, and increased risk of infection such as when your child attends a day care
Is it possible to prevent occurrence of febrile seizures in the future?
- Yes it is possible.
- The best method would be to prevent acquiring infection. Frequent hand washing can help you to minimize infections (general knowledge).
- If your child has an iron deficiency, this should also be treated as it is associated with occurrence of febrile seizures.
- Lowering the temperature with antipyretics or tepid sponging does not prevent seizures from occurring. It may reduce the temperature and make the child feel better. However, if the child does not like tepid sponging, it is better avoided.
- Use of paracetamol over and above the regular prescription should be completely avoided.
- In children, it is strongly advised to avoid giving NSAIDs (a stronger group of medication) for fever control.
- A lot of parents become very worried when their child develops even a mild fever. It is important not to panic. Instead you should be empowered by better understanding on how to manage a seizure if it ever were to happen.
- Taking medication also can prevent recurrences. There are two forms of medications that are used: Those used during a fever (intermittent prophylaxis) and those that are used on a daily basis (long term prophylaxis).
- These medications are however not without some concerns. The medications that we use during a febrile illness (Diazepam) causes sedation and result in undue worry and concern for both the parent and the doctor when the child remains drowsy while having fever. This may invariably warrant hospital admission and observation.
- The medications that are used on a daily basis also result in side effects inherent to the medication as well as require daily regular administration.
- Above all it will be for a long period. During this time, it is possible that your child may not develop even one episode of fever. Therefore, sometimes it may be that you have given this medication unnecessarily.
- Due to these factors, many guidelines do not routinely recommend using any form of preventive medication. These guidelines indicate that when the risks and benefits are weighed, giving these medications may not add much benefit to the child.
- However, in carefully selected patients, using these medications may be beneficial to them. Few examples include children who develop prolonged febrile seizures, those children being looked after by a care taker who is not competent of managing a seizure, those living far from a hospital etc.
- It is best to discuss these different options with your child’s physician.
- Most of the time you can manage your child without any medications.
- A lot of parents worry whether an EEG should be taken when their child develops recurrent febrile seizures.
- If they continue to be simple febrile seizures, performing EEG is not justified.
- However if there are recurring complex partial seizures particularly those with focal features or prolonged seizures, performing a basal EEG may be useful.
- Overall febrile seizures are a benign condition which outgrows with age.
- Majority of children have no additional risk of future epilepsy. They do not require long-term treatment.
- There is a smaller percentage who may have complex febrile seizures and who may require treatment.
- There is a very small percentage who may not stop having febrile seizures at 6 years.
- There are some others who have a history of developing both febrile seizures as well as afebrile seizures under the age of 6 years.