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Febrile seizures, also known as convulsions, body spasms, or shaking, occur mainly in children and are caused by fever. (Febrile is derived from the Latin febris,meaning fever.) As with most types of seizures, the onset is dramatic, with little or no warning. In most instances, the seizure lasts only a few minutes and stops on its own. Febrile seizures may occur because a child's developing brain is sensitive to the effects of fever. These seizures are most likely to occur with high body temperatures (higher than 102°F) but may also occur with milder fevers. The sudden rise in temperature seems to be more important than the degree of temperature. The seizure may occur with the initial onset of fever before a child’s caregiver is even aware the child is ill.
Seizures generally occur in those aged 3 months to 5 years; peak incidenceis in infants aged 8-20 months.
• • • •
About 2-5% of all children will experience a febrile seizure. Of those who have had a febrile seizure, 30-40% will experience more seizures. About 25% have a first-degree relative with a history of febrile seizure.
The seizure itself is almost always harmless. It does not cause brain damage or lead to epilepsy. Febrile seizures are classified into 2 types:
Simple febrile seizures are more common and are characterized by generalized seizures that last less than 5 minutes.
Complex febrile seizures are those that are either prolonged (longer than 15 minutes),focal (meaning they involve only a part of the body, such as the face), or recurring within a 24-hour period. Children who have experienced a complex febrile seizure may be at risk for these outcomes:
• • •
A somewhat higher risk of having a serious infection More likely to have preexisting neurologic abnormalities A higher risk for developing epilepsy later
Most fevers associated with febrile seizures are due to the usual causes of fever in young children—namely, common viral and mild bacterial infections such as ear infections. Although perhaps only 1% of children with febrile seizures have a serious infection of the central nervous system such as meningitis, this possibility should always be carefully considered in a child who has had a febrile seizure. By definition, febrile seizures occur when the child has a fever. Most febrile seizures are generalized. In other words, the whole body may be involved.
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During a generalized seizure, any or all of the following may be seen: Stiffening of the entire body Jerking of the arms and legs Complete lack of response to any stimuli Eyes deviated, staring, rolling back, moving back and forth Tightness of the jaws and mouth Urinary incontinence (wet their pants)
Noisy breathing, labored, slower than normal (unusual for a child to stop breathing completely)
Although it may seem like an eternity if you are witnessing a seizure, most of these episodes last only 1-5 minutes. Afterward, the child is typically drowsy but usually starts to become responsive within 15-30 minutes.
Following a seizure, a child may remain somewhat “twitchy,” with intermittent small jerks of the arms or legs. It can be difficult to distinguish these movements from seizure activity, but the caregiver should be reassured if the child’s body tone has become relaxed, breathing is regular, and the child begins to show some signs of responding to stimulation (will respond if talked to, for example).
Focal seizures are less common and, as the term implies, involve only a part of the body. Abnormal movements may be seen only in the face (eye blinking, lip smacking, other movements of the mouth) or one side of the body. Variable degrees of alteration in consciousness are seen in focal seizures. Some seizures begin as focal ones and then become generalized.
Seizures and Fever Treatment Self-Care at Home
These aspects of home care need to be considered:
Care of the child during the seizure: During a seizure, only a limited amount ofintervention should be undertaken. The main objective is to protect the child’sairway so that breathing is maintained. Protection from other injury is important.
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Remove objects, such as food and pacifiers, from the mouth. Place the child on his or her side orabdomen. Clear the mouth with a suction bulb (if available) if there is vomiting. Perform a jaw thrust or chin lift maneuver if there is noisy or labored breathing. Do not try to restrain the child or try to stop seizure movements.
Do not force anything into the child's mouth. Don't try to hold the tongue. (It is not necessary to try to prevent the tongue from being swallowed.)
Control of the fever: Because the seizure is being caused by fever, measures should be taken to lower the body temperature.
o o o
Remove clothing. Apply cool washcloths to the face and neck.
Sponge the rest of the body with cool water (do not immerse a seizing child in the bathtub). Give medication to lower the fever (acetaminophen suppositories in therectum, if available). Oral medications should not be given until the child is awake.
Consider the cause of the fever: This is probably best left up to the doctor's medical evaluation.
• If necessary. such as lorazepam(Ativan) or diazepam (Valium). respiratory rate. either with the use of a bag and mask or by placement of a tube in the trachea(windpipe). . Sometimes more than one dose or more than one type of medication is needed. or a device known as an oral airway. it seems reasonable to try to take these measures to control fever during an illness. it may be necessary to breathe for the child. If additional oxygen is needed. it is unclear how effective this is at preventing another episode of febrile seizures. chin lift. • Delivered through the IV line. the following interventions will be undertaken in the emergency department: • Emergency treatment is begun to make sure the airway is open and oxygen intake is adequate. Prevention • Although fever control is important. pulse. if fever is present Medications Medication is given to stop the seizure.Should the child come to the hospital with persistent seizure activity (what is termedstatus epilepticus). Tempra. and blood pressure) o Treatment to lower body temperature. which is the fastest and most reliable. Placement of an IV line to obtain blood for testing and to administer medication to stop the seizure A rapid bedside test for blood sugar (glucose) to determine if it is low and if glucose needs to be given through the IV (low blood sugar can cause seizures) o o Measuring vital signs (temperature. A monitor called a pulseoximeter will be used to measure oxygen content in the bloodstream. In some cases. a mask may be used. • The medications used often cause sedation. and other children's formulas as directed by your doctor or on the label) or ibuprofen(Motrin. Still. Advil. the airway may be opened by means of a jaw thrust. the child may remain sleepy for quite some time afterward. Give acetaminophen (Tylenol. • o Additional interventions may be needed as a physical examination is performed. the most commonly used medications arebenzodiazepines. Combined with the natural drowsy state after a seizure. and others).
or level of awareness. • Sponge bathing with lukewarm water must be done for 15-20 minutes. The lowering effect of sponge bathing on body temperature will not last unless the child has also been given acetaminophen or ibuprofen. A seizure occurs when the brain functions abnormally. attention. o • Neonatal seizures occur within 28 days of birth. can be frightening to the parent or caregiver. especially brothers and sisters. • A febrile seizure occurs when a child contracts an illness such as an earinfection. who have had febrile seizures are more likely to have a similar episode. Seizures.Febrile seizuresare the most common type of seizure seen in children. Why some children have seizures with fevers is notknown. Seizures may occur for many reasons. Two to five percent of children have a febrile seizure at some point during their childhood. One of every 100 childrenhas epilepsyrecurring seizures. Mostoccur soon after the child is born. especially in children. The water must not be so cool that the child shivers (shivering tends to keep body temperature up). or chickenpox accompanied by fever. • Around 3% of all children have a seizure when younger than 15 years.• Alternating doses of acetaminophen and ibuprofen such that medication is given every 3-4 hours is common. Children with relatives. although some authorities are concerned that this practice is of unproven safety and benefit. usually within a year. It may be difficult to determine if a newborn . school-aged children. o Children who are developmentally delayed or who have spent more than 28 days in a neonatal intensive care unit are also more likely to have a febrile seizure. resulting in a change in movement. Different types of seizures may occur in different parts of the brain and may be localized (affect only a part of the body) or widespread (affect the whole body). Seizures in newborns may be very different than seizures in toddlers. They may be due to a large variety of conditions. Children who have had a febrile seizure in the past are also more likely tohave a second episode. especially in a child who has never had one. but several risk factors have been identified. half of which are febrile seizures (seizure brought on by a fever). o o One of 4 children who have a febrile seizure will have another. and adolescents. cold.
With any suspicion of a long seizure. children with this type of seizurerepeat an activity. Often the child may haveincontinence (lose urine or stool). They are frequent upon awakening. o Tonic seizures result in continuous muscle contraction and rigidity. the childdoes not remember the event at all. Convulsive seizures are noted by uncontrollable muscle jerking lasting for a few minutes-usually less than 5-followed by a period of drowsiness that is called the postictal period. Simple partial (Jacksonian) seizures have a motor (movement) component that is located in one portion of the body. o • Status epilepticus is either a seizure lasting longer than 30 minutes or repeated seizures without a return to normal in between them. They are often associated with mental retardation and consist of sudden spasms of muscle groups. also known as petit mal seizures. After the seizure ends. such as clapping. These episodes usually do not last longer then a few seconds and start and stop abruptly.is actually seizing. if the child loses his or her place while reading or misses instructions for assignments. . with no apparent awareness of their surroundings. o • Generalized seizures involve a much larger portion of the brain. the childis oftendisoriented in a state known as the postictal period. Complex partial seizures are similar. These are sometimes discovered after the child's teacher reports daydreaming. are short episodes during which the child stares or eye blinks. They may have lip smacking or periods of no breathing. and most of these childrenhave generalized tonic-clonic seizures. Children with these seizures remain awake and alert. Frequently. Status epilepticus is very serious. you should call 911. because they often do not have convulsions. Theyhave no memory of this activity. their eyes appear to be looking in different directions. Instead. It is most common in children younger than 2 years. and it is normal for the child not to remember the seizure. o Absence seizures. Sometimes the jerking can cause injury. • o Partial seizures involve only a part of the brain and therefore only a part of the body. Movement abnormalities can "march" to other parts of the body as the seizure progresses. however. which may range from a small bite on the tongue to a broken bone. causing the child to assume a flexed stature. throughout the seizure. while tonicclonic seizures involve alternating tonic activity with rhythmic jerking of muscle groups. The child should return to his or her normal self except for fatigue within around 15 minutes. o Infantile spasms commonly occur in children younger than 18 months. except that the child is not aware of what is going on. They are grouped into 2 types: convulsive (muscle jerking) and nonconvulsive with several subgroups.
for 3 out of 4 children. sometimes with difficulty breathing and rolling eyes. The child is oftensleepy and confused after the seizure and does not remember the seizure afterward.• Epilepsy refers to a pattern of chronic seizures of any type over a long period. can help the doctor determine what type of seizure your child has had. A thorough description of the type of movements witnessed. In many of these cases. migraines. while othersimprove over time. night terrors. . head trauma. developmental problems such as cerebral palsy. Thirty percent of children diagnosed with epilepsycontinue to have repeated seizures into adulthood. This symptom group is common with grand mal(generalized) and febrile seizures. • The most common type of seizure in children is the febrile seizure. breathholding spells. which occurs when an infection associated with a high fever develops. the cause remains unknown. there is some family history of seizures. • o o o o o o o o Other reasons for seizures are these: Infections Metabolic disorders Drugs Medications Poisons Disordered blood vessels Bleeding inside the brain Many yet undiscovered problems Seizures in Children Symptoms Seizures in children have many different types of symptoms. as well as the child's level of alertness. and many other less common causes. These other disorders includefainting. The remaining causes include infections such as meningitis. About one fourth of the children who are thought to have seizures are actually found to have some other disorder after a complete evaluation. The child may undergo rhythmic jerking and muscle spasms. and psychiatric disturbances. • The most dramatic symptom is generalized convulsions. Although seizures have many known causes.
and any medications or chemicals that the child could have been exposed to. specifically to include where it occurred. or clapping. Tylenol) or ibuprofen (for example. These children return to normal as soon as the seizure stops. Exams and Tests For all children. the doctor may order blood or urine tests or both. The treatment for febrile seizures is keeping the temperature down. unless there was something unusual about the febrile seizures. It is important for the caregiver to tell the doctor about the child's medical history. followed by confusion are common in children suffering from a type of seizure disorder known as complex partial seizures. the doctorasks for a description of the event. Advil). o Most childrendo not get a CT scan of the head. such as the child not returning to his or her normal self shortly afterward. o Very few children with febrile seizures are admitted to the hospital. any recent illness. birth history. There are no convulsive movements. and some doctorsperform them in children as old as 18 months. a thorough interview and examination should occur. This testing depends on the child's age and suspected type of seizures. The lumbar puncture should be performed in children younger than 6 months. looking for the source of the fever. and possibly a medication o . • Repetitive movements such as chewing. Children with this type of seizure may also behave strangely during the episode and may or may not remember the seizure itself after it ends. then the doctor may want to perform a lumbar puncture (spinal tap) to test for possible meningitis. • Partial seizures usually affect only one group of muscles. These are called march seizures. lip smacking. Depending on the age of the child. A wide variety of tests can be performed on a child who is thought to have seizures. Spasms may move from group to group. • o Febrile seizures Children should receive medication for the fever such as acetaminophen (for example. which spasm and move convulsively.• Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking. o If the child has had his or her first febrile seizure. Additionally. which starts and stops quickly. and the period of sleepiness afterward. how long any abnormal movements lasted.
In children. he or she is given medications to stop the seizure. has another seizure. hasabnormal physical examination findings or lab test results. these imaging studies are usually normal but are performed to look for unusual causes of seizure such as bleeding or tumor. . then the medication'slevels in the blood are checked (if possible). o The child will probably be admitted if he or she is very young. then the child will probably have a few tests performed. which include partial seizures and generalized (grand mal) seizures. Follow up with the child's doctor in a few days. o • o Absence seizures (petit mal) These can be evaluated without going to an emergency department. which is a study looking at the brain waves or electrical activity of the brain. An EEG is almost never performed in theemergency departmentbutis performed later. If the child is having a seizure in the emergency department.if a specific infection is found such as an ear infection. If the EEG tells the doctor that the child is having absence seizures. or if you live far from a hospital. Most likely. and some other blood chemicals. o Most childrenundergo a CT scan or MRI (studies looking at the structure of the brain). sodium. o Most childreneventually undergo an EEG. Children in status epilepticus are admitted to an intensive care unit. Blood is drawn to check the child's sugar. the doctor will only order an EEG. then the child will most likely be placed on medications to control them. such as the EEG. o If the child is on antiseizure medications. and has a normal physical examination findings and blood test results. doesn't have recurring seizures. If the child has returned to normal in the hospital. can be very dramatic. o If the child is doing well. then the child will most likely be sent home to follow up with a pediatrician in a few days to continue the evaluation and arrange other tests. • o Movement seizures Movement seizures. but this may be scheduled for several days later rather than in the emergency department.
These children are usually admitted to the hospital and may even be referred to a pediatric specialty hospital. Many seizure medications have side effects including damage to your child's liver or teeth. and possibly a CT scan of the head. • o If medications are started The doctor will follow the drug levels. it takes weeks to months to adjust the medications. he or she will be treated very aggressively with antiseizure medications. most children with first-time seizures will not be placed on medications. seizures. and will watch closely for side effects. They would include blood and urine samples. lumbar puncture. which require frequent blood tests. . many doctors cannot be sure if the event was a seizure or something else. and possibly be placed on a breathing machine. There are some exceptions. If your child has status epilepticus. o Prevention Most seizures cannot be prevented. Children suspected of having these seizures may have multiple lab tests done in the emergency department. Unless a specific cause is found. these children undergo several days of testing to look for the many possible causes of the seizures. Often. o o Many children will have only one. and sometimes more than one medicine is needed. but these are very difficult to control. • o Important reasons for not starting medications During the first visit.• o Neonatal seizures and infantile spasms Seizures of this type occur in young children and are often associated with other problems such as mental retardation. or very few. Medical Treatment Treatment of children with seizures is different than treatment for adults. In the hospital. admitted to the intensive care unit. such as head trauma and infections during pregnancy.
• The biggest impact caretakers can have is to prevent further injury if a seizure does occur. • The child can participate in most activities just as other children do. Showers are preferred because they reduce the risk of drowning more than baths.Diseases and Conditions Migraine . Health Encyclopedia . Parents and other caretakers must be aware of added safety measures. • One common area for added caution is in the bathroom.What is it? Alzheimer's Symptoms MS Symptoms ABCDEFGHIJKLMNOPRSTUVWY .• Children who are known to have febrile seizures should have their fevers well controlled when sick. such as having an adult around if the child is swimming or participating in any other activities that could result in harm if a seizure occurs.
Description of Seizures In Children Please see the �Epilepsy (Seizure Disorders)� section for basic information about seizure types. subsequent Related Drug seizures may require evaluation also. especially with an infant who has a seizure with fever. and Instructor in Neurology. Harvard Medical School. especially if the seizure is prolonged or if the child does not recover afterwards in the same Information manner as in previous events. and medications. but complex febrile seizures may require such an evaluation. If a child has seizures both with and without Hospital Survival fever. . Three common seizure syndromes Animations are febrile seizures.. with no significant long term consequences for neurological development known to date and only a Videos slightly increased risk for epilepsy in the long term. Simple febrile seizures are not generally regarded as a form of epilepsy since the Reconstructing seizures are not spontaneous. is that such a seizure may be the first sign of meningitis. • Adderal XR Rolandic epilepsy is a common form of childhood epilepsy that is characterized by partial seizures. not all of Related which meet the criteria for epilepsy. there may be a higher risk of epilepsy and serious long term consequences for Saving Derek from neurological development.... MD. An important concern to Guide keep in mind. the child meets the criteria for epilepsy. a first time febrile seizure should be evaluated at the nearest hospital emergency department. that is. 2005. Rolandic epilepsy. The most common seizure type is the simple partial seizure. Seizures are characterized by abnormal electrical activity in the brain. and typically occur in children from the age of six months to five years. Assistant in Neurology. barring injury during the seizures Healthscout themselves. Boston. If there are features that mark the ACL's in Kids seizures as being complex (or �atypical�) rather than simple. duration).. There are a number of seizure syndromes that affect children. limited to one seizure for the duration of the illness. Simple febrile seizures. Febrile seizures are seizures that are triggered by fevers. An individual with epilepsy is someone who has recurrent spontaneous seizures. MA. Febrile seizures sometimes run in families. Depending on the circumstances.Seizures In Children • • • Definition of Seizures In Children Description of Seizures In Children Questions To Ask Your Doctor About Seizures In Children Definition of Seizures In Children Article updated and reviewed by Peter B. This disorder begins between infancy • Concerta and puberty. and occur in children who are developmentally normal and have no known chronic neurological Related disorders. Related Encyclopedia • Acne • Alagille Syndrome • Angina Pectoris • Angiogram More. emergency management. characterized by abnormal motor activity of a specific part of • Strattera More.. generalized (stiffening and shaking of all limbs).. Editorial review provided by VeriMed Healthcare Network on April 18. an electrical brainwave ADHD Diagnosis test like an EKG) or an MRI scan. and absence epilepsy. Children's Hospital Boston. Simple febrile • Dental Cavities seizure are ones in which the seizure is brief (up to several minutes in More. seizures that are not associated with triggers such as fevers or head trauma. are generally benign. usually causing changes in behavior such as rhythmic movements or confusion. Kang. Many children with complex febrile seizures Paralysis still do fairly well. Simple febrile seizures often do not require specialized Vision Revision for testing such as electroencephalography (EEG.. so any child with More.
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Breathing can be irregular. which is fever. and colds. The skin may appear to be darker than normal during an episode. Also.   The genetic causes of febrile seizures are still being researched. some children have a greater tendency to have seizures under certain circumstances) and a trigger. They may become incontinent (wet or soil themselves). Fever most of the time accompanies respiratory illnesses such as influenza. but uncommonly can last up to fifteen minutes. it is normally precipitated by a recent upper respiratory infection or gastroenteritis. The patient loses consciousness.  Febrile seizures represent the meeting point between a low seizure threshold (genetically and age-determined. they may also vomit or have increased secretions (foam at the mouth). however.Febrile seizure is a convulsion that is associated with a significant rise in body temperature in children ages of six months to five years.    Causes The direct cause of a febrile seizure is not known. the body will become stiff and the arms and legs will begin twitching. ear infections. pneumonia. croup. Some mutations that cause a neuronal hyperexcitability (and could be responsible for febrile seizures) have already been discovered. A fever itself is not an illness. A febrile seizure is the effect of a sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a prolonged length of time.  Symptoms During simple febrile seizures.  Several genetic associations have been identified. although their eyes remain open. It can occur also with various viral illnesses. The seizure normally lasts for less than one minute. but is associated with respiratory illness. sore throats. Febrile seizure is also known as fever fit or febrile convulsion.  These include: Typ OMIN Gene e FEB3 60440 SCN1A A 3 FEB3 60440 SCN9A . the eyes roll back.
although this is usually limited to evaluation of the urine in the younger age groups. This is caused by surrounding heat and not infection or respiratory illnesses. Heat-related illness or heat stroke is a more serious problem that is confused with fever. bacterial meningitis is very unlikely. in locales in which children are immunized for pneumococcal and Haemophilus influenzae. However. meningitis and encephalitis must be considered. It is important to prevent this and if it does occur to go to the pediatrician or emergency room immediately. If a child has recovered and is acting normally.  Types There are two types of febrile seizures. does not recur in . The diagnosis of a febrile seizure should not prevent evaluation of the child for source of fever. • A simple febrile seizure is one in which the seizure lasts less than 15 minutes (usually much less than this). which can lead to dangerous levels of body temperature. the prevalence of bacterial meningitis is low.B 3 FEB4 60435 GPR98 2 FEB8 61127 GABRG 7 2 Diagnosis The diagnosis is one that must be arrived at by eliminating more serious causes of seizure and fever: in particular. It occurs when children are in very hot places.
or a preconvulsion history of abnormal neurological signs or developmental delay. mental retardation. whereas an increased risk of death has been shown for complex febrile seizures. Children older than one year old have a 30 percent chance of a second seizure. Children who are younger than one year old that have a simple febrile seizure have a 50 percent chance of having another seizure.  Children with complex febrile convulsions are more likely to suffer from a febrile epileptic attacks in the future if they have a complex febrile seizure. the prognosis after a simple febrile seizure is excellent. Glauser TA: Febrile Seizures. or death. compared with the general public (1%) Template:Shinnar S.24 hours. and involves the entire body (classically a generalized tonic-clonic seizure). paralysis. 2002. They do not tend to recur frequently (children tend to outgrow them).4 . a family history of a febrile convulsions in first-degree relatives (a parent or sibling). • A complex febrile seizure is characterized by longer duration.  Treatment The vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences. Children two months or younger that have a rectal temperature of 100. partly related to underlying conditions. You can either use a digital electronic thermometer or an ear thermometer. Simple febrile seizures are more likely to be harmless that they do not cause brain damage. but should be reported immediately to the pediatrician.  Similarly. J Child Neurol 17S:S44. or focus on only part of the body. recurrence. and do not make the development of adult epilepsy significantly more likely (about 3– 5%). The first thing you do if you think your child has a fever is take the temperature with athermometer. nervous system problems.
which raise the child’s temperature. Both should be based on a child’s weight not his age.  Another way to manage is to combine medication with sponging or just use sponging alone.   The best way to manage is to control the temperature with acetaminophen and ibuprofen.degrees Fahrenheit or higher have a fever. Ask your doctor and pharmacist for the appropriate dosage.   Fever Seizures Topic Overview Check Your Symptoms Home Treatment Prevention Preparing For Your Appointment Related Information Credits Audio articles: English Español . Cold water can cause shivering. Using ibuprofen is approved only for children six months or older. Place your child sitting down in a regular bathtub with slightly warm water. It is not recommended to use aspirin to treat a simple fever. Children between three and six months of age with 101 degrees Fahrenheit or higher is a fever. Then sponge water all over the body until the temperature reached a good level. Children older than six months of age with a 103 degrees Fahrenheit or higher have a fever.
Fever seizures usually last 1 to 3 minutes. The child's eyes may roll back. A seizure is more likely to have been caused by a fever if the seizure occurred within 24 hours of the start of a fever. Fever seizures can be frightening but they are not usually harmful to the child and do not cause long-term problems. You can let the child sleep. Once a fever has reached a high temperature.Topic Overview Fever seizures (sometimes called fever convulsions) are uncontrolled muscle spasms that can occur in children who have a rapid increase in body temperature. but check the child frequently for changes in color or breathing. not just one side. It is important to protect the child from injury during a seizure. or pass stools. or learning problems. Check Your Symptoms . You may not even know your child has a fever. such as brain damage. The child may stop breathing for a few seconds and might also vomit. moving his or her arms and legs on both sides of the body. The rapid increase in body temperature in a short period of time may cause the fever seizure. After the seizure. The chance of another fever seizure varies with age. urinate. intellectual disabilities. Fever seizures usually affect the whole body. Most children who have a fever seizure have temperatures above 102 F (39 C). Most children have never had a fever seizure before and they also do not have other nervous system (neurologic) problems. Children can have another seizure. Fever seizures affect 2% to 5% of children. but normal behavior and activity level should return within 60 minutes of the seizure. Use the Check Your Symptoms section to decide if and when your child should see a doctor. These seizures are not a form of epilepsy. or twitching arms or legs. A child who is having a seizure often loses consciousness and shakes. but between 30% and 50% will have another within a year of the first one. The child also may seem confused after the seizure. the risk of a seizure is probably over. the child may be sleepy.
turn his or her head to the side and. • • • • Loosen clothing. Check your child for injuries after the seizure: • If the child is having difficulty breathing. . Comfort the child with quiet. soothing talk. Do not put anything in the child's mouth to prevent tongue-biting. using your finger. gently clear the mouth of any vomit or saliva to aid breathing. This will help keep the tongue from blocking the air passage so the child can breathe. This could cause injury. Keeping the head and chin forward (in the same position as when you sniff a flower) also will help keep the air passage open. Turn the child onto his or her side. Time the length of the seizure and pay close attention to the child's behavior during the seizure so you can describe it to your health professional.Home Treatment Protect your child from injury during a seizure: • • Ease the child to the floor. Try to stay calm. which will help calm the child. Do not restrain the child. which will help clear the mouth of any vomit or saliva. or lay a very small child face down on your lap.
but do not cause brain damage or affect intelligence. Having a febrile seizure does not mean that a child has epilepsy. Normal behavior and activity level should return within 60 minutes of the seizure. Prevention The best way to prevent fevers is to reduce your child's exposure to infectious diseases. Other symptoms of illness develop. (See "Patient information: Seizures in children" and"Patient information: Treatment of seizures in children". epilepsy is defined as having two or more seizures without fever present.• For home treatment of a fever.) CAUSES OF FEBRILE SEIZURES Infection — Febrile seizures can occur as a result of the fever that accompanies bacterial or viral infections. particularly after measles mumps rubella (MMR) vaccination. Check on the child often. Immunizations — Fever can occur as a side effect of certain vaccines. They can be frightening to watch. The fever typically occurs 8 to 14 days after the injection . Sleepiness is common following a seizure. especially human herpesvirus-6 (also called roseola or sixth disease).4º F (38º C). The majority of febrile seizures occur in children between 12 and 18 months of age. Febrile seizures occur in 2 to 4 percent of children younger than five years old. Age 4 and Older. Symptoms become more severe or frequent. Symptoms to Watch For During Home Treatment Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment: • • • Another seizure occurs with the same fever illness. be sure to follow your health professional's instructions. • If the child does not need to see a health professional right away. see the topic Fever. Age 3 and Younger or Fever. . FEBRILE SEIZURE OVERVIEW Febrile seizures are convulsions that occur in a child who is between six months and six years of age and has a temperature greater than 100. Handwashing is the single most important prevention measure for people of all ages. put him or her in a cool room to sleep. Seizures in children not related to fever are discussed in a separate topic review. If your child has had a fever seizure in the past and you have talked with your health professional about how to care for your child after a seizure. such as a cough.
the seizure is the first clue that the child is ill. After a simple febrile seizure. most children do not need to stay in the hospital unless the seizure was caused by a serious infection requiring treatment in the hospital.2ºF (39ºC). a serious infection of the lining of the brain. Complex — Complex febrile seizures are less common and can last more than 15 minutes (or 30 minutes if in a series). blood pressure. Febrile seizures are classified as being simple or complex. If the seizure stops on its own. Most seizures occur when the temperature is higher than 102. FEBRILE SEIZURE EVALUATION AND TREATMENT A child who has a febrile seizure should be seen by a healthcare provider as soon as possible (in an emergency department or provider's office) to determine the cause of the fever. After the seizure has stopped. antiseizure medication is not required. FEBRILE SEIZURE SYMPTOMS Febrile seizures usually occur on the first day of illness. usually by giving oral or rectal acetaminophen or ibuprofen and sometimes by sponging with room temperature (not cold) water. treatment for the fever is started. Some children. the child loses consciousness and has a convulsion or rhythmic twitching of the arms or legs. which involves inserting a needle into the low back to remove a small amount of fluid (cerebrospinal fluid or CSF) from around the spinal cord. the child may be confused or sleepy. Treatment for prolonged seizures usually involves giving an antiseizure medication and monitoring the child's heart rate. The child may have temporary weakness of an arm or a leg after the seizure. Most seizures do not last more than one to two minutes. Simple — Simple febrile seizures are the most common. may require testing to ensure that the fever is not related to meningitis.Risk factors — A family history of febrile seizures increases a child's risk of febrile seizures. although they can last up to 15 minutes. Other tests may also be recommended. Typically. particularly those less than 12 months of age. and breathing. The Table describes how to take a child's temperature (table 1). and in some cases. but does not have arm or leg weakness. . (See "Patient information: Meningitis in children". After the seizure.) The best test for meningitis is a lumbar puncture (also known as a spinal tap).
this occurs in approximately 30 to 35 percent of cases. In addition. acetaminophen or ibuprofen) to prevent fever is not recommended in a child without fever (eg. Parents of a child who is at risk of having a recurrent febrile seizure can be taught to give treatment at home for seizures that last longer than five minutes. if the child has a cold but no fever) because it does not appear to reduce the risk of future febrile seizures. Seizures that last for more than five minutes require immediate treatment. The risk of recurrent febrile seizures is higher for children who: • • • • • Are young (less than 15 months) Have frequent fevers Have a parent or sibling who had febrile seizures or epilepsy Have a short time between the onset of fever and the seizure Had a low degree of fever before their seizure Home treatment — Parents who witness their child's febrile seizure should take a number of steps to prevent the child from harming him or herself.4ºF or 38ºC) is acceptable but not always required. One parent should stay with the child while another parent calls for emergency medical assistance. Treatment for fever (temperature greater than 100. One dose is generally all that is required to stop a seizure. Most recurrences occur within one year of the initial seizure and almost all occur within two years. Treatment usually involves giving one dose of diazepam gel (Diastat®) into the rectum. the risks and potential side effects of daily antiseizure medications outweigh their benefit. Recurrent febrile seizures do not necessarily occur at the same temperature as the first episode. Preventive treatment — In most cases. (See "Patient information: Fever in children".RECURRENT FEBRILE SEIZURE Children who have a febrile seizure are at risk for having another febrile seizure.) FOLLOW-UP . Do not put anything in the child's mouth. A detailed discussion of fever in children is available separately. parents should speak with their healthcare provider for help in deciding when to treat a child's fever. giving medication (eg. • • Place the child on their side but do not try to stop their movement or convulsions. Keep an eye on a clock or watch. and do not occur every time the child has a fever. treatment to prevent future seizures is not recommended. available by dialing 911 in most areas of the United States.
arms. and do not occur every time the child has a fever. the seizure is the first clue that the child is ill. Intelligence and other aspects of brain development do not appear to be affected by a febrile seizure.) SUMMARY • • • • • • • • Febrile seizures are convulsions that occur in a child who is between six months and six years of age and has a temperature greater than 100. simple febrile seizure is only slightly higher than that of a child who never has a febrile seizure.4º F (38º C). However. Epilepsy occurs more frequently in children who have had febrile seizures. the recurrence rate is approximately 30 to 35 percent. The majority of febrile seizures occur in children between 12 and 18 months of age. Recurrent febrile seizures do not necessarily occur at the same temperature as the first episode. Febrile seizures can be frightening to watch. Children who have a febrile seizure are at risk for having another febrile seizure. or recurrent or whether it occurred in the setting of infection or after immunization. Febrile seizures usually occur on the first day of illness. they do not cause lasting harm.2 ºF (39ºC). particularly those less than 12 months of age. Most febrile seizures occur when the temperature is greater than 102. Febrile seizure can occur with infections or after immunizations that cause fever. the convulsion lasts 15 minutes or more. a serious infection of the lining of the brain. or legs that lasts less than one to two minutes. simple febrile seizure is only slightly higher than that of a child who never has a febrile seizure.Intelligence and other aspects of brain development do not appear to be affected by a febrile seizure. Epilepsy occurs more frequently in children who have had febrile seizures. the risk that a child will develop epilepsy after a single. the risk that a child will develop epilepsy after a single. . A child who has a febrile seizure should be seen by a healthcare provider as soon as possible to determine the cause of the fever. Some children. However. However. complex. may undergo testing to ensure that the fever is not related to meningitis. Less commonly. and having a febrile seizure does not mean that a child has epilepsy. (See "Patient information: Seizures in children". whether the seizure was simple. Most febrile seizures cause convulsions or rhythmic twitching or movement in the face. Most recurrences occur within one year of the initial seizure and almost all occur within two years. and in some cases.
These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause. if standing. or tens of seconds.fever induced Causes About 3 . Alternative Names Seizure . Most febrile seizures occur in the first 24 hours of an illness. and legs. Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -. The child may cry or moan from the force of the muscle contraction. A child is likely to have more than one febrile seizure if: • • • • • There is a family history of febrile seizures The first seizure happened before age 12 months The seizure occurred with a fever below 102 degrees Fahrenheit Symptoms A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body. arms.5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. .usually the muscles of the face. or those who still look ill when the fever comes down. and may pass urine. trunk. The child will fall. especially in children less than 1 year old. Toddlers are most commonly affected. The seizure is often the first sign of a fever or illness Febrile seizures are usually triggered by fevers from: Ear infections Roseola infantum (a condition with fever and rash caused by several different viruses) • Upper respiratory infections caused by a virus Meningitis causes less than 0.Febrile seizures Definition A febrile seizure is a convulsion in a child triggered by afever. Febrile seizures often run in families. and not necessarily when the fever is highest. The contraction continues for several seconds.1% of febrile seizures but should always be considered.
it is important to rule out other causes of a first-time seizure. • The child must not have had more than one febrile seizure in 24 hours. Finally. and may begin to turn blue. To avoid having to undergo a seizure workup: • • The child must be developmentally normal. the contraction is broken by brief moments of relaxation. Exams and Tests The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). A complex febrile seizure lasts longer than 15 minutes. and not confined to one part of the body. is in just one part of the body. The child's body begins to jerk rhythmically. or if saliva and mucus build up in the mouth. The child does not respond to the parent's voice. If possible. It is usually followed by a brief period of drowsiness or confusion. • The child must have a normal neurologic exam performed by a health care provider. the child will not need a full seizure workup. the examination usually shows no abnormalities other than the illness causing the fever. • • • • You may want to slide a blanket under the child if the floor is hard. Treatment During the seizure. The child must have had a generalized seizure.The child may vomit or bite the tongue. In infants and young children. Loosen any tight clothing. Move him only if he is in a dangerous location. A simple febrile seizure stops by itself within a few seconds to 10 minutes. turn him on his side or stomach. which includes an EEG. meaning that the seizure was in more than one part of the child's body. Remove objects that may injure him. leave your child on the floor. In a typical febrile seizure. and lumbar puncture (spinal tap). • The seizure must not have lasted longer than 15 minutes. open or remove clothes from the waist up. The movements are the same as in a grand mal seizure. or occurs again during the same illness. . Febrile seizures are different than tremors or disorientation that can also occur with fevers. head CT. This is also important if it looks like the tongue is getting in the way of breathing. especially around the neck. • If he vomits. especially meningitis. Sometimes children do not breathe. Typically.
simple febrile seizures are harmless. give the normal dose of ibuprofen or acetaminophen. the most important step is to identify the cause of the fever. Few children have more than three febrile seizures in their lifetime. Do NOT try to restrain your child or try to stop the seizure movements. These are usually prolonged. Most children outgrow febrile seizures by age 5. Focus your attention on bringing the fever down: • • • Insert an acetaminophen suppository (if you have some) into the child's rectum. mental retardation. a decrease in IQ. about half will have a third seizure. such as meningitis. Possible Complications • • • • • • • Biting oneself Breathing fluid into the lungs Complications if a serious infection. Sponge the rest of the body with lukewarm (not cold) water. • After the seizure is over and your child is awake. A small number of children who have had a febrile seizure do go on to develop epilepsy. or learning difficulties. Cold water or alcohol may make the fever worse. After the seizure. Outlook (Prognosis) The first febrile seizure is a frightening moment for parents. caused the fever Injury from falling down or bumping into objects Injury from long or complicated seizures Seizures not caused by fever Side effects of medications used to treat and prevent seizures (if prescribed) . Of those who do have a second seizure. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. but not because of the febrile seizures. However. as this increases the risk of injury. There is no evidence that they cause death. Do NOT try to give anything by mouth. Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. Most parents are afraid that their child will die or have brain damage. brain damage.Do NOT try to force anything into his mouth to prevent him from biting the tongue. epilepsy. About a third of children who have had a febrile seizure will have another one with a fever. complex seizures. The number of febrile seizures is not related to future epilepsy. Apply cool washcloths to the forehead and neck.
Seizures in childhood. Occasionally. References Johnston MV. or if this looks like a new type of seizure for your child. . However. eds. Jenson HB. Stanton BF. In: Kliegman RM. such as: • • • • • • • • • Abnormal movements Agitation Confusion Drowsiness Nausea Problems with coordination Rash Sedation Tremors It is normal for children to sleep or be briefly drowsy or confused right after a seizure. Philadelphia. Call or see the health care provider if other symptoms occur before or after the seizure. a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. Behrman RE. Pa: Saunders Elsevier.When to Contact a Medical Professional Children should see a doctor as soon as possible after their first febrile seizure. A febrile seizure does not mean that your child is not getting the proper care. 2007:chap 593. call 911 to have an ambulance bring your child to the hospital. If the seizure ends quickly. 18th ed. drive the child to an emergency room when it is over. Take your child to the doctor if repeated seizures occur during the same illness. Nelson Textbook of Pediatrics. Prevention Because febrile seizures can be the first sign of illness. no medication is completely effective in preventing febrile seizures. it is often not possible to prevent them. If the seizure is lasting several minutes.
Grand mal seizure A febrile seizure is a generalized tonic-clonic (grand mal) seizure that occurs in some children as a response to a fever. Febrile seizures are usually associated with rapidly rising fevers. and usually occur early in the fever rather than later. .
Generalized tonic-clonic seizure Definition A generalized tonic-clonic seizure is a seizure involving the entire body." convulsion. violentmuscle contractions. The peripheral nervous system includes all peripheral nerves. or as part of a repeated. It is also called a grand mal seizure. Generalized tonic-clonic seizures are the type of seizure that most people associate with the term "seizure. or epilepsy. Such seizures usually involve muscle rigidity. as a single episode.Central nervous system and peripheral nervous system The central nervous system is comprised of the brain and spinal cord. For more information see: • • • • • Seizures Epilepsy Fever (febrile) convulsions Petit mal or absence seizures Partial (focal) seizures . and loss of consciousness. chronic condition (epilepsy). They may occur in people of any age.
taste. the person usually has: • • • • • • • Normal breathing Sleepiness that lasts for 1 hour or longer Loss of memory (amnesia) regarding events surrounding the seizure episode Headache Drowsiness Confusion.tonic-clonic. Grand mal seizure. temporary and mild Weakness of one side of the body for a few minutes to a few hours following seizure (This is called Todd's paralysis. The seizure itself involves: • Loss of consciousness or fainting.20 seconds • Violent rhythmic muscle contraction and relaxation (clonic movement). usually lasting 15 . smell.grand mal.) For more information about diagnosis and treatment. or sensory changes. clenched teeth or jaw • Incontinence (loss of urine or stool control) • Stopped breathing or difficulty breathing during seizure • Blue skin color Almost all people lose consciousness. Seizure . After the seizure. This can include vision. Seizure .generalized Symptoms Many patients have an aura (a sensory warning sign) before the seizure. hallucinations. and most people have both tonic and clonic muscle activity.Alternative Names Seizure . usually lasting between 30 seconds and 5 minutes • General muscle contraction and rigidity (tonic posture). see: • • Epilepsy Seizures . or dizziness. usually lasting for 1 -2 minutes • Biting the cheek or tongue.
or twitching arms or legs. the child may be sleepy. The chance of another fever seizure varies with age.about. It is important to protect the child from injury during a seizure. but check the child frequently for changes in color or breathing.http://adam. intellectual disabilities. The child's eyes may roll back. Fever seizures can be frightening but they are not usually harmful to the child and do not cause long-term problems. Most children have never had a fever seizure before and they also do not have other nervous system (neurologic) problems. Once a fever has reached a high temperature. The child also may seem confused after the seizure. The rapid increase in body temperature in a short period of time may cause the fever seizure.htmhttp://adam.htm Print E-mail Fever seizures (sometimes called fever convulsions) are uncontrolled muscle spasms that can occur in children who have a rapid increase in body temperature. You may not even know your child has a fever. Fever seizures affect 2% to 5% of children. Children can have another seizure. Fever seizures usually affect the whole body. but normal behavior and activity level should return within 60 minutes of the seizure. Symptoms and Treatment ousdiseases/Febrile-seizures. urinate. These seizures are not a form of epilepsy. Fever seizures usually last 1 to 3 minutes. or pass stools. the risk of a seizure is probably over. The child may stop breathing for a few seconds and might also vomit. A seizure is more likely to have been caused by a fever if the seizure occurred within 24 hours of the start of a fever.com/encyclopedia/infectiousdiseases/Ge neralized-tonic-clonicseizure.com/encyclopedia/infecti Fever Seizures Causes. A child who is having a seizure often loses consciousness and shakes. or learning problems. but between 30% and 50% will have another within a year of the first one. Most children who have a fever seizure have temperatures above 102°F (39°C). such as brain damage.about. You can let the child sleep. not just one side. . moving his or her arms and legs on both sides of the body. After the seizure.
Use the Check Your Symptoms section to decide if and when your child should see a doctor. • .
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