As parents, we know about kids with colds, runny noses and ear infections. We’ve knelt with our stomach-sick children on the bathroom floor, and we’ve felt their foreheads and wiped their tears. But if a fever were to cause a seizure, few of us are equipped to respond.
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One in every 20 children with fever experiences a fever-related, or febrile, seizure. These children are typically between the ages of 6 months and 5 years.
A child may convulse or stiffen and lose consciousness for several minutes, then awaken and rapidly recover.
“It is traumatic to watch,” says neurologist Ajay Gupta, MD, Section Head of Pediatric Epilepsy in Cleveland Clinic’s Epilepsy Center. But most of the time, febrile seizures don’t happen more than once — whether during the same illness or as a result of future fevers.
Fewer than 5 percent of children who experience febrile seizures will go on to experience epileptic seizures, which do recur.
How seizures and epilepsy relate
The term “epilepsy” doesn’t refer to a specific disease, but to a tendency to have recurrent, unprovoked seizures over time. Possible causes of seizures in children and adolescents are:
“Most febrile or fever-related seizures are harmless,” Dr. Gupta says.
The 5 percent of children experiencing febrile seizures who develop epilepsy typically have one or more of the following indicators:
- Family history of epilepsy
- Neurological disability (e.g., cerebral palsy)
- Developmental delays
- Partial (one limb or one side) or prolonged (>15 minutes) or multiple febrile seizures during the same illness
Children without these risk factors most likely will not develop epilepsy, Dr. Gupta says.
What to do if your child has a seizure
“It’s very important that you don’t panic if your child has a seizure,” says Dr. Gupta. “Instead, try to stay calm and observe the child.”
To keep your child safe and prevent accidental injury during a seizure, he advises parents to do the following:
- Place child on a soft surface, such as a bed.
- Prevent choking by laying the child on his or her side or stomach.
- Ensure that the child is breathing adequately.
- Never place anything in the child’s mouth during a convulsion.
- Gently clean saliva or other debris from the child’s mouth with a soft cloth.
- Check the time when the seizure begins and note how long it lasts.
- Administer any treatment that your doctor has prescribed to stop seizure if this is a recurrence of febrile seizure. Call 9-1-1 if the seizure does not stop within three to five minutes or the child does not fully regain consciousness.
- When fully awake, give your child a medication (e.g., acetaminophen, ibuprofen) to reduce fever.
Dr. Gupta says most fever-induced seizures last for less than three minutes. He advises that you take your child to the pediatrician so your doctor can find the fever’s source.
Your description of your child’s seizure is important for helping the pediatrician with the evaluation. The doctor will likely perform physical examination and possibly some basic tests to ensure that nothing other than a fever has triggered the seizure.
“The child should be assessed to rule out an infection such as meningitis, as well as metabolic problems such as dehydration, low levels of glucose or sodium. Any of these underlying causes for seizure must be treated promptly,” Dr. Gupta says. “The only additional things the child needs are acetaminophen to lower the fever; hydration with water, soup or popsicles; and TLC.”
Dr. Gupta says parents should educate themselves about febrile seizures. Also, ask your pediatrician for tips on keeping your child’s fever down during an illness. This may decrease the chances of fever-related seizures.
Take faster action if you see these signs
If convulsions last five minutes or longer, take the child to the nearest medical facility for evaluation right away.
“Also, seek urgent medical attention for a child who shows symptoms of extreme lethargy, vomiting or a stiff neck,” says Dr. Gupta.
Other causes for concern include:
- A seizure that occurs on only one side of the body
- A fever of 104 degrees or higher
- More than one seizure in one day during the same illness
- A seizure with no associated fever or illness
If any symptoms cause you concern, contact your pediatrician.
Call 9-1-1 in two situations
The following situations are emergencies, Dr. Gupta stresses. Parents should call 9-1-1 promptly if:
- A child has a convulsive seizure that lasts longer than five minutes.
- A child has repeated seizures and does not fully return to normal in between them.
When to test for a neurological illness
Children with febrile seizures should be evaluated for neurological issues if they have:
- More than one seizure in 24 hours
- More than one seizure during a single illness
- Seizures affecting only one part or side of the body
- Developmental delays or an abnormal neurological exam
Neurological illness can cause repeated or longer-lasting febrile seizures and even seizures without fever, says Dr. Gupta. In both cases, additional testing is needed. And when doctors suspect that prolonged febrile seizures (longer than five minutes) are likely to recur, they can prescribe medication for parents to administer at home.
“Rapidly stopping the seizure may avoid an emergency room visit or hospital admission,” Dr. Gupta says.
Key takeaways for parents
Seizures have many causes and are fairly common in children, so don’t panic if your child has one.
It doesn’t necessarily mean he or she has epilepsy, nor does it mean the child has a greater risk of developing epilepsy in the future, says Dr. Gupta.
A seizure occurs when many brain cells abnormally fire at the same time. This temporarily disrupts the brain’s normal electrical signals. The intense, excessive electrical activity overwhelms the brain and may cause changes in behavior, awareness and body movements.