High body temperatures can sometimes cause seizures in infants and young children. These are known as febrile seizures. They can be very frightening, but they usually are not dangerous unless the child falls or has something in his or her mouth that causes choking.
Febrile seizure is the most common cause of convulsions in children. It is estimated that between 2 and 5% of children in the United States will have a febrile convulsion before the age of 5 years old.
The convulsion is associated with a rapidly rising temperature. Children who experience febrile seizures usually have rectal temperatures above 102[degrees]F. But most children who run a fever that high will never have a febrile seizure.
The seizures often occur shortly after the fever starts. During a typical febrile seizure, the child loses consciousness and his arms and legs begin to shake. Less often, the child becomes rigid or has twitches in only one part of the body, such as one arm or leg, or on only the right or the left side. Most febrile seizures last a minute or two, although some can be as brief as a few seconds.
What Are Febrile Seizures?
A febrile seizure is defined as a seizure associated with fever and having no evidence of another identifiable cause in a previously healthy child between 6 months and 5 years of age.
What Are The Types Of Febrile Seizures?
Febrile seizures can be classified as:
Simple febrile seizures, are a single generalized seizure of less than 15 minutes' duration. It is the most common type of febrile seizure.
Complex febrile seizures last longer than 15 minutes, occur more than once in 24 hours, or affect only certain parts of the body. About 15% of febrile seizures are complex. A child with a complex febrile seizure has a higher risk of developing recurrent febrile seizures.
How Common Are Febrile Seizures?
About 1 in every 25 children will have at least one febrile seizure, and about one third of these children will have more. Febrile seizures usually occur between the ages of 6 months and 5 years, although they may occur in children as old as 6 or 7 years. Children rarely have their first febrile seizure before age 6 months or after age 3 years.
Are Febrile Seizures Harmful?
Although febrile seizures can be very frightening, they are, in most cases, harmless. These seizures do not damage the brain or nervous system. During a seizure, there is a small chance that the child may be injured by falling or may choke on food or saliva.
What Should Parents Do?
It's most important for a parent of a child who is having a seizure is to stay calm. Most seizures stop on their own within a few minutes. Nonetheless, witnessing a seizure in an infant or young child can be very frightening.
When a child is having a seizure you should:
1. Create a safe environment for the child on the floor or ground.
2. Place the child on his or her side to prevent choking on saliva.
3. Don't restrain the child's movements during the seizure.
4. Don't put anything in the child's mouth.
5. Talk to the child softly, letting him or her know you are there to help.
6. Keep an eye on the clock. If the seizure lasts more than 10 minutes, call a physician, or take the child to the nearest hospital.
Who Treats Febrile Seizures?
A febrile seizure can be treated by a family physician, pediatrician or, in certain situations, a pediatric neurologist.
When Should I Call The Doctor?
Contact the child's doctor in case of:
* Seizures lasting more than 10 minutes
* Repeated convulsions
* Focal seizures--seizures affecting only parts of the body
* If the seizure is different from the past ones
* If it is your child's first febrile seizure
* If you have any concerns about your child's health or well being
Under these circumstances the child may need further evaluation. Only your child's doctor can make this decision. Remember, when in doubt, seek professional medical advice.
What's the Best Way to Treat A Fever
There is controversy about whether a child's fever should be treated at all. It may be wise to try and control a fever in a child who has a history of febrile seizures.
Acetaminophen (Tylenol, Panadol, and others) and ibuprofen (Motrin, Advil, Nuprin and others) may reduce your child's fever or help with other symptoms, but there is no convincing evidence that theiy reduce febrile seizures. Due to the risk of Reyes Syndrome, aspirin should be avoided.
Tepid sponging is often used to reduce fever. However its effectiveness is limited and many doctors feel it is a waste of time. If it seems to make your child more upset, then stop. If you do bathe your child, use only water. Never use rubbing alcohol!
If the seizure has stopped, then no specific therapy is necessary for seizure. What's important is treating the underlying cause of fever.
Once the seizure has ended, the child must be reassessed about the cause of fever and need for further treatment.
Although there are effective therapies that could prevent the occurrence of additional simple febrile seizures, the potential adverse effects of such therapies are greater than their benefits. Moreover, there is no convincing evidence that any therapy will prevent the possibility of future epilepsy (a relatively unlikely event).
Does A Child With Febrile Convulsions Need To Be Admitted To The Hospital?
Most children with febrile seizures may be safely managed at home. However your child's doctor may decide to admit your child to the hospital if:
* This is her first febrile seizure
* She is less than 18 months old
* She has febrile status epilepticus (multiple seizures without regaining consciousness)
* The parents are very anxious
* She is very sick from her underlying illness
What Factors Determine The Risk Of Recurrence Of Febrile Seizures?
A child who has had a febrile seizure has a higher risk of the seizure recurrence during any subsequent episodes of high fever. The chances are higher under the following circumstances;
* Young age at onset of first febrile seizure, less than 12 months
* A history of febrile seizures in a first-degree relative (brother, sister, mother, father)
* Seizures in a patient with low degree of fever, defined as less than 104[degrees]F rectally
* Brief duration, less than one hour between the onset of fever and the initial seizure
* Complex partial seizures
About 30% of children have more than one attack. Each febrile episode increases the risk of recurrence by 18%. Each degree of increase in temperature (Celsius) during subsequent infections almost doubled the risk of recurrence. (One degree Celsius is equal to 9/5 of a degree Fahrenheit).
Is Febrile Seizure The Same As Epilepsy?
No, epilepsy and febrile seizures are not the same. A febrile seizure is a convulsion occurring in relation to a febrile episode. If the fever is controlled, the chances of having a seizure lessens. Febrile seizures don't occur in the absence of fever.
Epilepsy, on the other hand, is a condition with recurrent seizures and is basically due to an excessive electrical discharge in the brain. In the majority of cases the cause of epilepsy is not known. However, it may be associated with trauma at birth, head injury or it may follow infections. Epilepsy needs to be treated.
What's The Risk Of Developing Epilepsy?
The risk of epilepsy with simple febrile seizure is low. Risk factors include complex febrile seizures, preexisting mental retardation or cerebral palsy and a family history of epilepsy.
Is There A Need For Antiepileptic Therapy?
There is no role for antiepileptic therapy (medicines to control seizures) in the treatment of children with uncomplicated simple febrile seizures. Based on the risks and benefits of the effective therapies, neither continuous nor intermittent anticonvulsant therapy is recommended for children with one or more simple febrile seizures. However anticonvulsant may be considered if the child:
* Had abnormal neurological development
* Had long (more than 30 minutes.) or focal seizures
* Had more than 2 seizures in 24 hours (even if both are febrile seizures)
* Has a family history of epilepsy in parents or sibling
* Was very young as there is an increased risk of having status epilepticus.
Are There Any Long-term Effects Of Febrile Convulsions?
Most children who have a febrile seizure have an excellent prognosis. Clinical studies suggest that febrile convulsions in early childhood do not have adverse effects on behavior, scholastic performance or neurological development. Children who had recurrent febrile convulsions performed as well as other children in terms of their academic progress, intellect, and behavior.
What A Parent Should Remember
Parents should remember that febrile seizures are relatively common, almost always don't cause any long lasting problems, and may be scarier to the parents than the child.
Dr. Jaiswal is based at Ahmedabad, India. She is a Medical Advisor/ Pharmaceutical Physician with Intas Pharmaceuticals. In addition, she also serves as associate editor of Contemporary Medicine, an Indian publication for family physicians.
COPYRIGHT 2002 Pediatrics for Parents, Inc.
COPYRIGHT 2002 Gale Group
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