Want to know what scares many parents? – Fevers and the potential of febrile seizures.
What are febrile seizures? Can we prevent them? Will they harm your child’s development? Will kids always have one if they get a fever?
Check out the PedsDocTalk YouTube Video: Pediatrician Discusses Febrile Seizures for more details and guidance on navigating febrile seizures, including simple vs. complex febrile seizures, causes of febrile seizures, what they look like with videos, and what to do during and after a febrile seizure.
What is a febrile seizure?
A febrile seizure is a seizure in an infant or young child that occurs when the child has a fever, or temperature above 100.4F. Febrile seizures occur in 2-4% of children between the ages of 6 months and 5 years. The peak incidence of febrile seizures is around 18 months of age. Although they can be scary for parents to witness (and I have witnessed my share as a Pediatrician), let’s discuss more to provide some guidance.
Febrile seizures are classified as either simple or complex. For more information about febrile classifications – watch this PedsDocTalk YouTube video.
What causes febrile seizures?
Febrile seizures are an age-dependent phenomenon, likely related to a vulnerability of the developing nervous system to the effects of fever in combination with an underlying genetic susceptibility.
One of the greatest risk factors for febrile seizures is family history. The siblings of a child who experiences a febrile seizure have a 10-20% risk of having a febrile seizure as well.
For a febrile seizure to BE a febrile seizure, there has to be a seizure. Interestingly, it’s not always high fevers (ones over 102, it can also happen with fevers at 101).
It’s important to note that although febrile seizures occur with a fever, NOT ALL fevers will result in a seizure. So it is a misconception to say ALL fevers lead to seizures.
Check out this YouTube video for more information on fevers, when evaluation and treatment are recommended, and misconceptions about fevers.
What does a seizure look like?
Most of the time a febrile seizure occurs on the first day of illness. Sometimes the seizure may be the first sign a child is sick! A seizure usually occurs with sudden onset.
A child will not respond to you and may have a blank stare or with twitching or rolling eyes. They may appear to stiffen or shake parts of their body.
The jerking of the body is rhythmic and cannot be suppressed by holding an extremity like for example a normal newborn tremor. Some children drool, vomit, or urinate, although these are less common symptoms. Most seizures last less than a few minutes but they can sometimes last longer. Most children return to their normal mental state after the seizure but some do experience a phase after where they seem confused, agitated, or tired called a post-ictal state. Those symptoms should be self-limited and resolved within 5 minutes.
For videos about what a seizure looks like, watch this PedsDocTalk YouTube video.
What to do if a seizure happens?
I have seen many seizures in my career. My son had a seizure in my arms as a newborn (not a fever seizure), so I get it. It’s scary. It truly is. So I’m giving you this advice as a mom of a child who has had seizures and as a Pediatrician.
First, try to stay calm! Seizures can be scary to watch but the most important thing is making sure your child is in a safe environment.
- Move them carefully to the floor or bed, away from anything that could hurt them.
- Turn their head to the side and avoid putting anything into their mouth, including your fingers because they may bite you. This will make it easier for them to clear any drool or vomit from their mouth in a side-lying position.
- Try to time how long the seizure lasts, which is helpful for us clinicians to determine the diagnosis. In the moment, 1 minute can feel like 20 minutes – so time it.
- If the seizure lasts more than 5 minutes, call 911. If it makes you feel better, you can always call 911 when the seizure begins especially if this is the first time for the support. If the seizure lasts less than 5 minutes, but the child is also not perking up, also call 911.
- Most seizures stop on their own but rarely medication is required to get them to stop so it’s important to get medical help on the way.
Is treatment needed?
After a first febrile seizure occurs, it’s important to reach out to your pediatrician or go to an emergency room.
Most will want to evaluate the child, mainly to determine the cause of the fever. Likely the cause is viral, but a workup may be done (bloodwork, nasal swabs, and urine studies to confirm it’s nothing bacterial that needs treatment).
Rarely, if more serious symptoms are present or the seizure is atypical they may order further testing like a lumbar puncture (where they take fluid safely from the spine to make sure there is no infection) or refer the child to a neurologist.
Most of the time, though, as long as the child has recovered well, no further treatment will be needed.
Giving fever-reducing medication, like acetaminophen or ibuprofen as needed for fever or discomfort may reduce the risk of the seizure. However, seizures can occur even with fever-reducing medicines so don’t think you failed or did something wrong.
Because febrile seizures are usually benign and self-limited, it is not typically recommended to give anticonvulsive medications to prevent seizure activity. Generally, the risks of these medications outweigh any possible benefit.