Febrile Seizures in Children

Febrile seizures are convulsions that typically occur when a child’s rectal temperature is above 102 degrees Fahrenheit. [Remember that rectal temperature is 1 degree higher than an oral temperature and one degree lower than a axillary (under the arm) temperature. In other words-- if an oral temperature reading shows 101 on the thermometer, than a rectal temp would be 102 and an axillary temp would be 100. The most accurate way to take an infants temperature is rectally. ] The seizure is a response to a sudden rise in body temperature. It is the sudden spike in temperature, not how high the fever reaches that actually causes the seizure. Because a child’s temperature can spike so suddenly, sometimes the febrile seizure is the first sign that the child is even running a temperature or sick. However, febrile seizures can occur at any time during the course of a fever, but are most common within the first 24 hours of fever.

Most commonly the child has some sort of viral infection or illness that causes a fever, but more serious central nervous system infections should always be ruled out. Meningitis, a life threatening inflammation of the brain and spinal cord, causes less than 0.1% of febrile seizures, but should always be considered. It is common for children to run rapidly spiking temperatures after receiving immunizations, so the immunizations can indirectly be the culprit. Children rarely have a febrile seizure before the age of six months or after the age of five.

One third of children that have a febrile seizure will have at least one additional febrile seizure. The risk factors for recurrenceinclude: onsetbefore 18 months, shorterduration of fever before the seizure occurs, and a familyhistory of febrile seizures, and having an initial complex febrile seizure- (defined below.) Genetic and familial factors may increase susceptibility to febrile seizures, but these studies are inconclusive.

General symptoms of a febrile seizure:

• Loss of consciousness or become unresponsive
• Jerking or shaking of arms, legs, or entire body.
• Eyes may roll backwards.
• Difficulty breathing.
• Involuntary urination.
• Vomit
• Cry or moan
• Ridged body
• Twitching in an isolated area of the body- such as side of mouth or hand.
• Fever greater than 102 degrees.

Febrile seizures are classified as simple or complex :

Simple febrile seizures. These are the most common, accounting for 90% of febrile seizures. They last from a few seconds to 15 minutes and stop on their own. The entire body will jerk or shake. After the seizure, a child may cry, act confused, or be lethargic (sleepy or tired). Anticonvulsant medicines are generally not needed.

Complex febrile seizures. These are more serious. A complex febrile seizure lasts longer than 15 minutes, occurs more than once within the same period of illness, or is isolated to one side/ area of the child’s body.

It is impossible to prevent a febrile seizure. Antipyretics like Tylenol or Ibuprofen will aid to help the child fell better and reduce the fever. However, they will not prevent the febrile seizure. Neither will luke warm baths, rubbing the child with alcohol, etc prevent the febrile seizure.

What to do when the child is having a febrile seizure:

• Stay calm.
• Make a mental note of the time.
• Turn the child on their side and place them in an area that does not have any sharp objects or items that can injure the child- (avoid holding or restraining the child.)
• Remove any objects from the child’s mouth and do not put any thing in the child’s mouth. Items in the mouth can be bitten off and obstruct the airway.
• Carefully observe the child. Watch for any difficulty breathing or skin color changes. If either occur, call 911 immediately.
• If the seizure persist for greater than 10 minutes, call 911. Otherwise call your doctor or local emergency room when the seizure is over.

Treatment:

If the seizure is still happening when the child arrives at the ER, Dilantin, Valium, or Ativan may be given. Otherwise, the doctor will perform tests to pinpoint the source of infection, rule out CNS infections, and then treat the infection. Occasionally, the doctor might prescribe an anticonvulsant like diazepam after multiple episodes, prolonged febrile seizures, or if the child does not have immediate access to medical care. However, most of the time anticonvulsant drugs are not recommended, due to their side effects and questionable effectiveness.

Outlook:

The long-term outlook is excellent. The vast majority of children with febrile seizures do not have seizures (without fever) after age 5. There is not any risk or evidence of risk that shows febrile seizures cause brain injury, learning disability, etc. Injuries can occur if the febrile seizure occurs when the child is standing and falls on an object. Sometimes the tongue can be bit during the seizure. Other than the terrible fright experienced by the parent, febrile seizures are rather harmless. The exception is the rare prolonged seizure that lasts greater than 30 minutes. Scar tissue in the temporal lobe of the brain can form from seizures lasting longer than 30 minutes, which can lead to chronic epilepsy.