Febrile Seizures

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By: Natalie L. Boehm, MBA, RBLP-T

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What are febrile seizures?

Febrile seizures are convulsions in a child caused by a spike in body temperature. The most common cause of a febrile seizure is infection. Febrile seizures often occur in children who do not have a history of neurologic symptoms and disorders. Febrile seizures are the most common seizures in children, affecting two to five percent of children between the ages of six and sixty months (Steering Committee, 2008). There are two types of febrile seizures: simple and complex.

Simple vs. complex febrile seizures

Simple febrile seizures are more common than complex. Simple febrile seizures can last from a few second to up to fifteen minutes. They do not reoccur within a twenty-four-hour period and are not specific to one part of the body.

In the article, Febrile Seizures: Clinical Practice Guideline for the Long-Term Management of the Child with Simple Febrile Seizures, there are four adverse outcomes that may be altered due to an effective therapeutic agent. These outcomes are:

1. A decline in IQ

2. Increased risk for developing epilepsy

3. A risk of recurrent febrile seizures

4. Death

In most situations, children who have experienced a simple febrile seizure, do not have to start anticonvulsant medication. For those who do, medications such as phenobarbital, primidone, valproic acid, carbamazepine, and phenytoin are prescribed. While effective in controlling seizures side effects such as hypersensitivity, lethargy, sleep disturbances, weight loss/gain, and gastrointestinal disturbances.

Complex febrile seizures are less common. Complex febrile seizures last more than fifteen minutes and occur more than once in a twenty-four-hour period. They are often confined to one side of the body. Because of risk of long-term complications, testing such as an EEG or MRI may be ordered.

In some rare cases a lumbar puncture (spinal tap) may be ordered to determine if an infection is suspected. Infections such as meningitis which effects the central nervous system is one situation where a lumbar puncture is likely to be ordered by a physician.

Symptoms of febrile seizures

Symptoms that can arise from a febrile seizure are:

  • High fever/rapid rise in body temperature
  • Loss of consciousness/fainting
  • General muscle contraction and tremors lasting 15-20 seconds
  • Biting of cheek or tongue or clenching of the teeth/jaw
  • Loosing control of urine or stool
  • Difficulty breathing

Seizure first aid for febrile seizures

Here are the steps to help a child who is having a febrile seizure:

1. Stay calm. Place the child on his/her side on a surface that will prevent them from falling and sustaining injury.

2. Start timing the seizure.

3. Make sure there are no items around that can cause harm to the child. Do not restrain the child.

4. Place a folded blanket or piece of clothing under their head to prevent injury to their head.

5. By removing clothing, increasing air circulation in the room can help to reduce their body temperature. Do not put an ice pack on them or place them in the tub. It will cause more harm than help.

6. Do not put anything in their mouth.

7. If the seizure lasts more than 5 minutes or reoccur, seek medical attention.

Treatment for febrile seizures

In most cases, medication is not prescribed for febrile seizures. For more complex cases, rectal diazepam (Diastat) or nasal midazolam may be prescribed to treat seizures lasting more than five minutes. These are known as emergency medications and not used for seizure prevention. Antiseizure medication, as the examples listed above, are known to cause side effects that can cause physical and emotional complications to a child. Unless deemed medically necessary, they will not be prescribed. 

Conclusion

Febrile seizures are convulsions caused by a spike in body temperature. Infection is the most common cause of a febrile seizure. There are two types of febrile seizures: simple and complex. It is essential to know the signs and symptoms of a febrile seizure and know what steps to take to provide proper first aid for a child having a febrile seizure.

Resources:

British Red Cross (2021). First Aid for a baby or child who is having a febrile seizure. British Red Cross. Retrieved from: https://www.redcross.org.uk/first-aid/learn-first-aid-for-babies-and-children/febrile-seizure

Cleveland Clinic (2020). Febrile Seizures. Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/7001-febrile-seizures

Lee, D. et. al. (2018). Complex Febrile Seizures, Lumbar Puncture, and Central Nervous System Infections: A National Perspective. Academic Emergency Medicine25(11), 1242–1250. https://doi.org/10.1111/acem.13441

Mayo Clinic (2019). Febrile Seizures, Diagnosis and Treatment. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/febrile-seizure/diagnosis-treatment/DRC-20372527

Mayo Clinic (2019). Febrile Seizures, Symptoms and Causes. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/febrile-seizure/symptoms-causes/syc-20372522

Steering Committee on Quality Improvement and Management, S. (2008). Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures. Pediatrics (Evanston)121(6), 1281–1286. https://doi.org/10.1542/peds.2008-0939

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