By Dr Vinod Jacob
Febrile seizures (febrile convulsions) are fits that can happen when a child has fever. They are the most common type of seizure in paediatric age group. They most commonly happen between the ages of 6 months to 6 years. The cumulative incidence is estimated about 5-7% and the peak incidence is noted at 18 months of age. It can be frightening and distressing to see your child having a seizure (fits), particularly if it is the first episode they are witnessing.
However, the good news is that, the febrile fits are usually harmless and majority of the children recover completely after the incident without any neurological or cognitive dysfunction.
But remember, some children with certain risk factor may have recurrence of febrile fits and rarely some can harbour neurological problems like tendency to develop a condition called epilepsy.
How to identify febrile seizure
Child having fever suddenly becomes stiff and their arms and legs begin to twitch, lose consciousness, do not respond to your calls, and may wet or soil themselves. They may also vomit and foam at the mouth and their eyes may roll back.
Sometimes the child will have only a vacant stare for few seconds, or some may only twitch one side of the body. Usually the febrile fits lasts for less than five minutes, and post seizure your child may sleep for about one hour, and has complete recovery afterwards.
It rarely happens that the fits may last more than 10 min, or there are multiple seizure activity in 24 hours, fits affect one half of the body, or child does not have a complete recovery after the episode. Such febrile fits are called complex febrile seizure and these group of children requires immediate hospitalisation because they are vulnerable for recurrence and may progress to develop epilepsy or some neurological dysfunction if proper treatment is not commenced as early as possible.
What to do during a febrile seizure
First of all do not panic. As I have stated earlier, most of the febrile fits are harmless and your child will recover within 5-10 minutes. When you panic, you are prone to do more harm than good to the child.
When you witness a seizure, first and the foremost thing is to place the child in a safe position: i.e. place the child down in clear and safe surroundings.
Turn the child to left or right side, so as to prevent any aspiration of saliva or froth. Loosen the shirt near the neck, so that it helps in breathing comfortably.
Do not try to give any medication through the mouth due to risk of aspiration.
Try to note how long the seizure lasts, which all limbs are involved in twitching and other signs such as up rolling of eyes and frothing of oral cavity, because these history will aid the treating doctor to categorise the seizure into the common simple febrile seizure or the rarer complex febrile seizure.
Contact a specialist for any further advice and take the child to hospital after the active seizure gets over.
Call an ambulance if seizure lasts more than 5 minutes.
What causes febrile fits?
There is no clear cut answer; however, studies have shown a strong link with the genetic factors contributing to the etiology.
The chance of your child getting a febrile seizure is high if any of the first degree relative is having the same issue.
The background prevalence risk of 1 in 30 rises to 1 in 5 where one sibling is affected and 1 in 3 if both parents and a previous child have had febrile seizure.
Parents should understand that it is the fever that triggers the seizure, hence the cause for fever should be investigated and the underlying infection needs to be treated.
What are the investigations done for febrile seizure?
Generally speaking, simple febrile seizure is a clinical diagnosis – we investigate mainly to find the cause for fever and treat the underlying infection. In children, respiratory illnesses, ear infection, viral fevers, urinary tract infection and gastroenteritis are the common underlying cause for fever.
These can be confirmed by a chest X-ray, blood and urine tests. However, the major concern for the treating doctor is the central nervous system infection. In this case, the spinal fluid (CSF) analysis can confirm the diagnosis.
Red flags suggestive of increased risk for central nervous system infection in a child with febrile seizure.
* History of irritability, headache, vomiting, photophobia, neck stiffness
* who are lethargic and not feeding well
* Prolonged drowsiness after the seizure (lasting more than one hour)
* Complex febrile seizure
* Children with decreased consciousness level before seizure activity
What are the risk of recurrence of febrile seizure and the risk for epilepsy?
Parents should know that up to a third of children have recurrence, and 75% of them happen within one year of the first episode. As the age advances the chance for recurrence comes down.
Risk factors for recurrence include:
* Age at onset under 18 months
* History of febrile seizure in first degree relatives (parents and siblings)
* Relatively low degree of fever associated with fever
* Multiple seizures during the same febrile illness
Management of febrile seizure
Simple febrile seizure though frightening experience for parents, will subside within 5 minutes and its crucial to shift your child to a safe place and do necessary actions to prevent aspiration of saliva or froth and keep the airway clear for breathing. Investigate the underlying cause for fever and treat the primary infection.
Children with recurrent febrile seizure and those at risk for epilepsy require special attention and further investigations which can be done under the guidance of a paediatrician. Parents of children with recurrent febrile fits should undergo training in first aid medications that should be given at home.
* Dr Vinod Jacob is an MBBS, MD (Paediatrics) and works at Aster Hospital, Doha as a Specialist – Pediatrics & Neonatology
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