General Illness Information
Common Name: Seizures, febrile, febrile fits.
Seizure occurring with fever in infancy or childhood without evidence of other underlying cause. It is triggered by rapid rise in temperature in infants and children. Febrile convulsions typically occur with rising temperature followed by altered consciousness and uncontrolled muscle spasms. They can occur in up to 4% of children between ages of 6 months to 4 years. They do not cause any brain damage. Of all the children who get febrile seizures, only a few children (3%) have seizures without fever later on in life.
60% of children have just one febrile seizure.
40% of children with febrile convulsions may have 2-3 recurrences.
- Sudden, high fever from any cause, combined with an unexplained irritability of the central nervous system in some children. Temperature usually greater than 39°C (102.2°F), but rate of change may be more important than temperature.
- May also be associated with certain viral infections e.g. upper respiratory infections, roseola infantum, influenza A, gastroenteritis.
- May occur after immunization–mumps, measles, rubella immunization (MMR) within 7-10 days or diphtheria, pertussis, tetanus immunization (DPT) within 48 hours.
- May occur with certain bacterial infections e.g. Shigella, salmonella, otitis media
- When fever begins in a child who has had a febrile convulsion in the past, begin measures to reduce the fever right away (Acetaminophen 10 mg/kg orally or rectally or ibuprofen 10 mg/kg – for temperature greater than 38°C (100.5°F) rectal)
- May use intermittent prophylactic rectal diazepam for fever greater than 38.5°C (101.3°F).
Signs & Symptoms
Fever (102.2F [39C] or over) usually precedes the convulsions, but in 25% of patients seizure is the initial sign of illness . Other symptoms include:
- Jerking or twitching of the arms, legs or face that lasts 2 to 3 minutes.
- Duration is less than 15 minutes with simple seizures and average frequency is once in 24 hours.
- Loss of bladder or bowel control.
- Irritability upon regaining consciousness, followed by deep sleep for several hours.
- Seizure in sibling raises risk 2-3 times
- Repeated infections.
Diagnosis & Treatment
First episode of seizure needs investigation especially if patient is under 12 months of age. Blood tests including blood cultures and in some cases lumbar puncture may be performed to rule out other causes of seizure.
- Reduce fever by removing child’s clothing and applying cold wash cloths to face and neck. Sponge rest of the body with cool water. As the water evaporates, the child’s temperature will come down. When the seizure is over and the child is awake give acetaminophen and encourage cool fluids.
- Protect the child’s airway, that is, ensure that the child’s breathing passages are clear.
- If child has anything in the mouth, clear it with a finger to prevent choking.
- Place child on the side or abdomen, face down to drain the secretions (use suction bulb if available).
- If child’s breathing becomes noisy, pull the jaw and chin forward.
- During the seizure do not restrain the child or stop the seizure movements. Once started, the seizure will run its course, no matter what you do.
- Do not try to force anything into the child’s mouth, its not necessary and may cause injury to mouth or tooth.
- Anticonvulsants are not usually prescribed and are only considered in recurrent and complicated seizures.
- Main purpose of treatment is controlling fever with acetaminophen and sponge baths and appropriate antibiotic for bacterial infection.
Keep the child resting quietly in bed until fever and the underlying illness are gone. Then allow activity to return gradually to normal.
Nothing by mouth during seizure. After the seizure ends, encourage the child to drink extra liquids, including water, tea, cola and fruit juice.
- Body injury during a seizure.
- Children with febrile seizures are at slightly greater than average risk to develop epilepsy later in life. Epilepsy occurs in 0.5% of general population but in 3-4% of population with prior febrile seizures.
- Recurrence risk is about 20-40%; almost all those that recur, do so within one year
A convulsion caused solely by fever in a child is usually not serious.
However, other causes should be investigated.
It is important to note that seizures do not cause retardation, developmental delays or behavioral abnormalities.
If the first convulsion with fever occurs in a child younger than 6 months, a neurological examination and other studies may be necessary.