Febrile Seizures

What is it?

Febrile seizures is the name we give to seizures (convulsions or "fits") that happen in young children as a result of fever. They are very different from "regular" seizures or epilepsy. Febrile seizures happen in children between the ages of six months and six years, usually with a fever over about 102.4 °F or 39 °C. The seizure usually happens very early in the fever – often so early that the parent had no idea the child even had a fever. Febrile seizures may be slightly more common in children who have infections with a virus called HHV6. HHV6 is the virus that causes Roseola and other viral illnesses in children.

Doctors usually talk about febrile seizures in two categories:

• "Simple" febrile seizures are by far the most common. A simple febrile seizure lasts for less than 15 minutes and does not recur within 24 hours once the child is fully recovered. Simple febrile seizures involve both sides of the child’s body symmetrically. Simple febrile seizures do not require any special testing or treatment. Most primary care doctors feel very comfortable taking care of children with simple febrile seizures without referring them to a neurologist.
• "Complex" febrile seizures are those that either last for more than 15 minutes, recur within 24 hours, or are "localized" to one side or area of the child’s body. Complex febrile seizures can be associated with other conditions that are more serious. Most doctors will do some testing in children with complex febrile seizures, such as blood tests, CT scans, or EEG (brain wave) tests. Many doctors will refer these children to a neurologist, depending on the results of the testing.

Parents of children with febrile seizures are usually very frightened by the seizure, and have many urgent concerns. Here are the most common concerns and their answers:

• Will my child have brain damage or mental retardation?  No. Seizures of any kind do not cause brain damage unless they last a very long time. By definition febrile seizures do not. Children with febrile seizures always recover normally.
• Does my child now have epilepsy or a seizure disorder?  No. There is no connection between having febrile seizures and epilepsy. Children with epilepsy may have a seizure if they develop a high fever, but they also have seizures frequently when they do not have a seizure.
• Does my child have to take seizure medications?  No. The use of seizure (anticonvulsant) medicines in children with febrile seizures does not help to prevent the seizure.
• Will it happen again?  Probably not. About 70% of children with a first-time febrile seizure never have another, even when they get fevers. Of course, that means that about 30% do have another. We’ll talk about how to handle that below.
• Will it happen every time my child gets a fever?  No. Most children never have another febrile seizure, even with a fever.
• Will my child outgrow this?  Absolutely yes. Children have almost always outgrown their febrile seizures by the age of six years. If they continue to have seizures after that, they are defined as having a seizure disorder.

We treat the seizure and the fever parts of this condition separately. During a seizure we want to be sure a child keeps an open airway, keeps breathing well, and has normal blood circulation. When your child had his or her first seizure, chances are the ambulance crew or hospital personnel took care of that. It is easy to do yourself, especially because children with febrile seizures almost never get into trouble with these things. Here are the "ABC’S" of seizures – you may want to copy these and post them near your telephone and other places in your house. You may want to give copies to your daycare providers and others who care for your child.

 The ABC’s Of Seizures

A – Airway: Place the child on his or her side and support the head. Put one hand on each side of the child’s face and hold the head in a slightly "tipped up" or "sniffing" position. This allows air to move easily into and out of the lungs.

B – Breathing: Allow the child to breathe on his or her own. Breathing is often irregular or shallow. That is normal. Often there is saliva or foam at the mouth. Wipe it clear of the nostrils but do not put anything in the child’s mouth.

C – Circulation: Children with seizures have fast but otherwise normal heart rates. DO NOT start CPR on a child who is having a seizure.

D – Don’t: Do not ever put anything (belt, wallet, your fingers) into a child’s mouth during a seizure. S/he will not "swallow the tongue" and you can cause a blocked breathing passage.

E – Emergency Phone Numbers: The doctor’s phone number is: ___________________. Call 911 if the child’s skin seems blue or if you think s/he is not breathing well.

There is debate among doctors about using medicines to prevent a febrile seizure once a fever has started. The most recent recommendation of the American Academy of Pediatrics (AAP) is that most children do not benefit from any anti-seizure medication, either long-term or just during fevers. For children whose families might have an unusually hard time dealing with a febrile seizure, the AAP recommends that doctors consider whether to give an oral anti-seizure medicine with the start of a fever.

We take care of the fever in children with febrile seizures the same way that we do in any child with a fever. Please read our Aftercare Instruction on Fever. Some doctors check blood tests in younger babies with fever, and if they are concerned about the results, they may give an antibiotic shot. There is no need for antibiotics just to treat the seizure. Children with febrile seizures are not more likely to have dangerous conditions such as meningitis or other serious infections, so further testing is not usually needed.

You can use acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) to relieve fever in children with febrile seizures. These medications will not prevent a febrile seizure, however, so please do not drive yourself or your child crazy with dosing. Fever is not dangerous, but it can make the baby uncomfortable. If your baby seems comfortable there is no reason to give any medication just for fever. Please do not give cold-water baths or alcohol rubs for fever. These actually make a child shiver and can increase body temperature.

Febrile seizures are always frightening, even if you have become used to them. The best thing to do during the seizure is to follow our "ABC’s" of seizures, above. When in doubt, call an ambulance – no one will blame you! Here are a few other things that might cause concern:

• An unusually long seizure, or any seizure lasting more than 5 minutes
• Any seizure that seems to involve only one side of the child’s body
• Seizure without a fever
• Any suspicion that a child has something in the mouth at the time the seizure started, that might cause choking
• A child who was unusually sleepy or very irritable just before the seizure happened
• Any seizure in a baby younger than 6 months of age, with or without a fever

If any of these occur, please be sure to call your doctor’s office right away. If your child or infant has a seizure lasting more than 5 minutes, is difficult to awaken or seems unconscious, call 911.

After a seizure, children are often dazed, quiet, or sleepy for as long as 4-6 hours. This is the normal "post-ictal" period and is the time when the child is recovering. During this time, some children may develop a temporarily paralyzed arm, leg, or part of the face. This is called "Todd’s paralysis" and can be very frightening, but it will go away on its own. Please do let your doctor know if you see this happening, though, so s/he can keep tabs on you.

Children often have a bowel movement or empty their bladders during a seizure. This is normal and not in the child’s control.

Most children with a seizure during a fever are having a febrile seizure. There are a few exceptions:

• A very small number of children with meningitis (infection of the coverings of the brain and spinal cord) can have a seizure. This is usually happens only after several days of being sick, not on the first day of fever. Children with meningitis appear very ill and have high fevers. They may have a stiff neck, or a bulging fontanel (soft spot), or be extremely irritable or sleepy.
• A disease called "encephalitis" (enn-seff-a-light-us) is an infection of the brain itself. Viruses are the most common cause of encephalitis, though other germs can cause it as well. Symptoms of encephalitis usually involve changes in level of activity or consciousness, such as extreme irritability or extreme sleepiness. They can also include unusual behavior, hallucinations, and disorientation.
• Some children who turn out to have epilepsy have their first seizure with a fever. If this happens we may say that the child has febrile seizures until the first time s/he has a seizure without a fever. Any seizure without a fever should raise a concern about epilepsy.
• Very rarely, a child with a serious condition such as a brain tumor has a seizure as the first sign of it. This is usually without a fever, and often involves only one side of the child’s body. If your doctor suspects something like this s/he will do a CT scan or other test to look at the brain structure.

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.