Advice on Febrile seizures

 

Witnessing a child having a seizure is a traumatic event; even more so if you are the parent of that child. It results in a great deal of anxiety in the witnesses and angst about the future. There are some important things that should be highlighted in the context of febrile seizures that hopefully can help alleviate some of this anxiety.

 

Overview

  • Febrile seizures are the most common seizure disorder in childhood.

  • Although in many sources it is classed under the ‘Epilepsies’, a diagnosis of a febrile seizure in your child does not mean they have Epilepsy. There is a slight increased risk for epilepsy if you have had a febrile seizure, about twice the risk in the general population.

  • Febrile seizures occur only in the context of a fever so it is important to note whether your child was hot at the time of the seizure or soon before or after.

  • There are 3 types of febrile seizures:

    • Simple febrile seizures

    • Complex febrile seizures

    • Symptomatic febrile seizures

  • Simple febrile seizures are the most common (70-75%) and occur in the setting of fever in a child aged between 6 months to 5 years of age who is otherwise neurologically healthy, last less than 15 minutes as a single seizure, and the fever (and seizure) is not caused by meningitis, encephalitis, or other illnesses affecting the brain.

  • If the seizure is focal (doesn’t involve both sides of the body), prolonged, occurring as a cluster of seizures back to back, or the child has a pre-existing neurological abnormality, it is not a simple febrile seizure. The same is true if the child is younger than 6months or older than 5years.

  • The underlying cause of febrile seizures is not known but a genetic predisposition clearly contributes to their occurrence.

  • One third of children with a previous simple febrile seizure will have another one; if the child is younger than 12 months at the time of their first febrile seizure they have a 50% chance of another, after 12 months of age this probability decreases to 30%.

  • There is no evidence to suggest that simple febrile seizures cause learning disability, brain damage, or even increase the risk of death.

  • Being male gives you a slightly (but definite) higher risk for febrile seizures.

  • No evidence suggests that any therapy (medication) administered after a first simple febrile seizure will reduce the risk of a subsequent non-fever associated seizure or Epilepsy.

  • On the basis of risk/benefit analysis neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures.

 

General Advice for simple febrile seizures

 

What to do for my child during an illness with fever

  • If the child (older than 6months) has a temperature above 103Farenheit (39.4Centigrade) please consult a physician urgently.

  • Note down any associated symptoms the child has:

    • cough, sore throat, wheeze, noisy breathing, chest pain/tightness, vomiting, diarrhea, rash, small purple spots on the skin (that may look like bruises), earache, headache, neck pain or stiffness, lethargy, labored or exhaustive breathing, reduced level of consciousness, light avoidance, runny nose, streaming eyes, reduced urine amounts, pain or difficulty passing urine, limb pain, reduced use of a limb, grey pale or blue color to skin.

      • All symptoms in Red may need more emergent medical attention so consult early i.e. the same day.

 

  • Be proactive:

    • Seek early consultation with a physician to diagnose the cause of the fever and assess the need for hospitalization, investigation and/or antibiotics.

    • Employ measures to keep their temperature down and stable

      • Give acetominophen (e.g. Tylenol) and/or ibuprofen (e.g. Advil) following advice from your doctor.

      • Strip the child down.

      • Encourage plenty of oral fluids.

      • Place a fan in the child’s room.

      • If you wish to give your child sponge baths use lukewarm water.

      • However possible increase your vigilance.

  • If your child has a fever for more than 3 days consult a physician.

  • Listen to your instincts – if you believe your child is getting sicker seek a physician’s advice.

 

If my child goes on to develop a seizure

  • Try to note whether the child is currently hot and the time i.e. length of the episode as well as its appearance.

  • Seizures can involve: eyes rolling back, upper/lower limbs or whole body jerking, vacant periods, body stiffness.

  • There is usually a period of time following the seizure when the child is sleepy, dozy, or disorientated; this is normal and called the postictal phase.

  • If it is a first episode then attend the emergency department immediately with/without consultation with a pediatrician if you have one.

  • If this is a repeat episode

    • Don’t panic

    • Note the details as above.

    • If the child returns to normal (after the postictal phase) and you are not concerned, consult a physician at your next convenient opportunity but do consult.

 

What should I expect at hospital

  • Your child to be thoroughly examined head-to-toe.

  • Laboratory blood tests and X-Rays to only be carried out upon clinical suspicion; No tests may be done at all.

  • To be told a working diagnosis for the cause of the febrile illness but this may only be a clinical diagnosis i.e. not confirmed with investigations.

  • Not necessarily to be given any medication for seizures.

 

The purpose of the hospital visit is primarily precautionary, secondarily to reassure you as a parent, and thirdly document the event as well as any findings.

 

 

References:

Canadian Pediatric Society

 

312 - 15336 31 Avenue

Surrey, BC V3Z 0X2

Tel: 604-560-8709

Fax: 604-560-8720

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