How To Diagnose And Treat Febrile Seizures In Children

Febrile Seizure, in simple terms, is convulsions in children that generally cause fever. The cause of such convulsions in children may not be infection in the spinal cord or brain nor any neurologic cause. It is sometimes referred to as fever-induced seizure.

Causes of Febrile Seizure in Children

Febrile seizure is a common condition among children in the age group of 9 months to 5 years. At least 3–5% of children in this age group show symptoms of this fever-induced febrile seizure. Although this a common condition among toddlers, febrile seizure can be traced to family histories. If a child is ill since 24 hours then the first fit of febrile seizure will occur in that period. It is not mandatory that febrile seizure occurs only when the body temperature is uncontrollably highest.

Febrile seizure can also be regarded as a potential sign or symptom of fever. Fevers caused by ear infections, viral respiratory infections, meningitis and Roseola Infantum (virus initiated fever and rash) are the most common types of fevers that result in febrile seizure. Although only 0.1% of febrile seizure is caused by meningitis, it should not be neglected, especially in infants below the age of 1 year.

Risk Factors for Febrile Seizures

A child is highly prone to febrile seizure if he/she belongs to a family with its other members having febrile seizure in the past, if there had been a febrile seizure earlier before the child completed 12 months age and if the febrile seizure occurred at body temperature below 102ºF.

Symptoms Of Febrile Seizures

Rolling of eyes and stiffening of limbs are considered to be mild symptoms of febrile seizure. However, febrile seizure may lead to full-blown convulsion of the entire body. A sudden contraction in the muscles of the face, arms, legs and the trunk is the first sign of febrile seizure. Such muscle contraction induces the child to cry with pain. The muscle contraction may last for seconds and then the child might fall down or start urinating. Biting of tongue and vomiting are similar signs of febrile seizure. In several cases, the child stops breathing all of a sudden and hence turns all blue. Relaxing for a few moments would put an end to muscle contraction in the child’s body thereby leading to jerking of the body.In such a situation, the child completely stops responding to any voice asking to calm down.

In general, a febrile seizure lasts not more than 10 minutes. The moment of febrile seizure is followed by confusion of the child. Complex febrile seizures last past 15 minutes. A complex febrile seizure is the one that persistently occurs in a particular body part. It is to be noted that febrile seizures are quite apart from tremors that are also accompanied with fever. However, body movements in case of tremors and febrile seizures are more or less similar.

Diagnosis of Febrile Seizures

The child complaining febrile seizures is diagnosed on the basis if he/she has mal seizure without any recent history of epilepsy. Doctors generally do not consider meningitis as a possible cause for febrile seizure in infants as well as young kids.

Common febrile seizures do not show signs of any other abnormality in the child other than fever. In such a case, the child needs not undergo examinations such as EEG (electroencephalography), spinal tap and head CT, which is together known as full seizure workup.

Avoiding full seizure workup – Normal febrile seizures do not require full seizure workup comprising of tests such as EEG and head CT, accompanied with spinal tap. For avoiding the seizure workup, certain pre-conditions must be kept in mind. It must be ensured that the child exhibits normal growth, it was a case of general febrile seizure occurring in more than just one body part and not in a particular body part, the seizure lasted less than 15 minutes, there was a single febrile seizure in a span of 24 hours and not more than that and the child has undergone a proper neurologic test prior to examination for febrile seizure.

Treatment of Febrile Seizures

Parents can cure the child undergoing febrile seizure by following a few simple steps.

Parents should leave their child lying on the floor during febrile seizure. In case the flooring is very hard, parents can simply slide down a blanket. Parents should try to move from his position and movements only when he/she is nearing some dangerous location such as near a heater.

While the child is rolling on the floor, parents should move dangerous things away from the child to avoid injury. If the child’s neck is covered with a scarf or any other tight piece of cloth such as a muffler then parents should remove it immediately. In fact, parents should try to remove all clothes above the waist. Vomiting, building up of mucus inside the child’s mouth and prevention of breathing by the tongue can be prevented by turning the child to lay on his/her stomach. However, tongue biting should not be prevented by forcefully putting anything inside the child’s mouth. That would only increase the injury risk. Also, parents should not prohibit the seizure movements.

Rather, parents should be focused towards decreasing the body temperature/fever of the child. To do so, parents should insert (in case it is handy) an acetaminophen suppository into the rectum of the child. Avoid medicating through mouth. Parents can apply cloth piece soaked in cold water on neck as well as the forehead, as is done during normal fever. The rest of the body should be sponged with cloth piece soaked in lukewarm water. When the febrile seizure is completely gone, the child should be given ibuprofen which can also be substituted with acetaminophen. When the febrile seizure is over, it is time to find out the actual cause of the child’s fever.

It is advised to call a doctor when any of the symptoms given below appear. The symptoms are agitation, drowsiness, confusion, abnormal movements or unsteady walk, nausea, coordination problems, tremors, sedation and rash.

Prognosis

First febrile seizure for a child comes as a shock to most parents. But there is no need to worry as simple ones do not affect the child’s normal development. In simple febrile seizure, there is no harm of epilepsy, decreased IQ, mental retardation or even death. However, in few cases of complex febrile seizure, children do head toward epilepsy. All children outgrow febrile seizure when they get older than 5 years.

Prevention

There is no way to prevent directly febrile seizure as it is the first symptom of development of other illness such as fever. In most cases, the child is treated with diazepam that can be used in every subsequent case of febrile seizure.