Febrile Seizures In A Child: Causes, Symptoms, And Treatment

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Febrile seizures in children are seizures triggered by fever and occur in one in 25 children. Febrile seizures are a common type of seizure in healthy children, and they may occur between six months and five years. According to the National Institute of Neurological Disorders and Stroke data, nearly two to five percent of children under five years experience at least one febrile seizure episode.

Read on to know more about febrile seizures, their types, causes, symptoms, diagnosis, treatment, and prevention.

Types Of Febrile Seizures In Children

Febrile seizures in children can be classified into the following two types.

1. Simple febrile seizures

  • Most of the febrile seizures in children are simple febrile seizures.
  • These last for less than 15 minutes.
  • Shaking is seen on both sides of the body.
  • They do not occur more than once in a 24-hour period.

2. Complex febrile seizures

  • These are less common and may last for more than 15 minutes.
  • Shaking happens on only one side of the body.
  • They may occur more than once in a 24-hour period.

Causes Of Febrile Seizures In Children

The following factors may cause febrile seizures in children.

  • Rapidly increasing fever, usually above 101°F (38.3°C)
  • Viral infections, such as the common cold, or upper respiratory infections with associated fever
  • Bacterial infections, such as urinary tract infections, ear infections, or other infections, that cause fever
  • Familial tendencies
  • Genetic factors

Signs And Symptoms Of Febrile Seizures

According to the US National Library of Medicine, the following are all symptoms of febrile seizures.

  • Upward rolling of the eyes
  • Stiffening of limbs
  • Muscle contractions lasting for several seconds or longer on both sides of the body
  • Crying or moaning
  • Falling from the standing position
  • Vomiting
  • Tongue biting
  • Breathing problems and cyanosis (turning blue)
  • Rhythmic jerking of the child’s body
  • Not responding to the parents’ voices
  • Passing urine

Note that the symptoms may vary in each child. Further, these symptoms may also be seen in other conditions, such as a nervous system infection called meningitis. Thus, always consult a doctor for the right diagnosis and treatment.

Complications Of Febrile Seizures

According to NHS, febrile seizures have been linked to an increased risk of epilepsy. While children with a history of febrile seizures may develop epilepsy, the risk is low.

  • It is estimated that children with a history of simple febrile seizures have a one in 50 chance of developing epilepsy at some point in the future.
  • Those with a history of complex febrile seizures have a one in 20 chance of developing epilepsy at some point in the future.
  • Those with no history of febrile seizures also have a one to two in a 100 chance of developing epilepsy.

Diagnosis Of Febrile Seizures In Children

In a typical febrile seizure, the doctors may not recommend a full seizure workup if there are no other symptoms of the illness apart from the fever.

A full seizure workup is advised in the following scenarios.

  • The child is younger than nine months or older than five years
  • History of a brain, nerve, or developmental disorder
  • Seizures only occur on one side of the body
  • A seizure lasting for longer than 15 minutes
  • More than one febrile seizure in 24 hours

A full seizure workup may involve an EEG (electroencephalogram), head CT scan, MRI (magnetic resonance imaging), lumbar puncture (spinal tap), and blood tests.

Testing for the underlying pathology causing fever

Some fevers may have serious underlying causes. A thorough medical and physical history after an episode of a febrile seizure may pinpoint conditions such as:

  • Meningitis
  • Encephalitis

Spinal taps may be performed to confirm or rule out the diagnosis of these conditions.

Tests to understand the risks associated with seizures

Children with complex febrile seizures are at a higher risk of developing epilepsy. The following tests help in assessing the risk for epilepsy.

  • Electroencephalogram (EEG)

This test uses electrodes to record brain waves to gauge the risk of recurrence of a seizure. It is a painless procedure.

  • Brain scans

A CT scan or MRI creates detailed images of the brain. It helps in detecting the underlying cause that may lead to seizures in children.

When To Call A Doctor

Call the local emergency number if you notice a seizure lasting for several minutes. Inform the emergency service to get an ambulance along to carry the child to a hospital. If the seizure ends quickly, you can drive the child to the nearest hospital.

You must contact your child’s doctor if your child has more than one seizure episode or seizures that appear to be of a new kind.

If your child has symptoms of a seizure, along with any of the following symptoms, call the doctor.

  • Abnormal movements
  • Tremors
  • Disoriented coordination
  • Confusion
  • Agitation
  • Drowsiness
  • Nausea and vomiting
  • Rash

Treatment And Management Of Febrile Seizures In Children

Treatment plans are available for both the treatment and prevention of febrile seizures. Read on to know how to manage febrile seizures in children.

Managing the child while a febrile seizure is happening

During a seizure episode, parents must stay calm, get help if needed, observe the child, and avoid any restraints.

You may follow these steps.

  • Lay the child on one side as it allows secretions to drain from the mouth.
  • Lay the child on a flat surface and make sure that there are no toys or sharp objects around as they may cause a physical injury.
  • Do not try to put anything in the child’s mouth during the episode.
  • Watch out for signs of breathing problems such as bluish discoloration of the skin (cyanosis).
  • Try to gauge how long the seizure lasts. Most seizures last between 30 seconds to two minutes.

Medications

The doctor may prescribe medicines to end the seizure. The medicines are usually administered rectally. The doctor or nurse will train you on how to administer these medicines rectally.

After the seizure, focus on the underlying causes of fever and ways to bring the fever down. Common treatments for fevers in children include acetaminophen and ibuprofen (used only in children older than six months).

The children might feel sleepy, tired, confused, or agitated after the seizure. Be composed and let them rest.

Preventing Febrile Seizures In Children

Although febrile seizures cannot be prevented, doctors might prescribe diazepam to prevent or treat recurrent febrile seizures.

The risks of developing epilepsy after a fever are low, and therefore, anti-seizure medicines are not prescribed to prevent recurrent febrile seizures. In some cases, the doctors may prescribe a short-term benzodiazepine bridge. It is given to children when they have a fever and a history of recurrent febrile seizures.

Frequently Asked Questions

1. Can febrile seizures cause brain damage?

According to the American Academy Of Pediatrics (AAP), “Febrile seizures do not cause brain damage, nervous system problems, paralysis, intellectual disability, or death.”

2. Can febrile seizures cause behavior problems?

No. There’s no conclusive evidence that febrile seizures affect the behavior, intelligence, and school performance of a child.

3. What to do after a child has a seizure?

After the seizure, console the child and reassure them that everything is alright. Once the child looks pacified, take their temperature, and give medication for fever or pain if necessary. Next, call your doctor and seek advice. Depending on their understanding of the case, the doctor may ask you to visit them the next day or take them to the emergency room.

4. Should I let my child sleep after a seizure?

It’s normal for a child to feel sleepy after a seizure. So, stay with your child until they are awake and once they look drowsy, let them sleep and take ample rest. Don’t give your child anything to drink or eat until they are fully awake and alert.

In most cases, febrile seizures in a child do not cause concern, although they can be worrisome for parents and caregivers. It might be simple or complex, depending on the episode’s length. Common symptoms are upward rolling of the eyes, stiffening limbs, vomiting, fainting, breathing problems, etc., that require medical assistance. You must maintain your calm during an episode and follow the steps outlined above. By five years of age, most children outgrow febrile seizures, and the disease has little or no impact on the child’s ability to learn and grow.

Key Pointers

  • Febrile seizures in children are caused by factors such as fever, infections, or genetics.
  • Eye rolled upwards, limb stiffening, and tongue biting are some of its symptoms.
  • If the child displays additional symptoms besides fever, you can go for tests such as EEG and brain scans.
  • Treatment typically involves medication and home management.

References:

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Dr. Jessica Madden

(MD, FAAP, IBCLC)
Jessica Madden is a pediatrician, neonatologist, lactation consultant, and mother of four, who has been taking care of newborns since 2001. She works as a neonatologist in the NICU at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, and founded Primrose Newborn Care, a newborn medicine and “4th trimester” home-visiting and telemedicine practice, in 2018.  Dr. Madden is a Fellow... more

Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. She also holds a certificate in lactation counselling from iNational Health... more

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