What are febrile seizures?
Febrile seizures are described as generalized (whole brain and body involved), tonic-clonic (shaking) movements of a child’s body in response to a high fever. These seizures represent abnormal brain electrical activity triggered by fever.
How common are they?
Febrile seizures are very common, occurring in up to 2% to 4% of all children during the early childhood years. These occur normally in children between 6 months and 6 years of age, with the majority of children experiencing their first febrile seizure at a median age of 15 to 21 months.
What are some characteristics of children with febrile seizures?
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Typical febrile seizures cause generalized shaking of the body lasting 1 to 2 minutes, with a rapid return to consciousness.
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These seizures tend to occur with a rapid rise in body temperature and usually happen only once during any given illness.
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Often febrile seizures happen at the start of an illness, sometimes before the fever is even apparent.
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Atypical febrile seizures are different from typical seizures in the following ways:
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Seizure is prolonged and may last longer than 15 minutes.
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Seizure is focal, or partial, and involves just part of the body.
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A child experiences more than one seizure during the same febrile illness.
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A child younger than 6 months or older than 6 years.
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A child with preexistent neurologic or developmental problems.
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A strong family history for epilepsy.
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Most children who have febrile seizures are developmentally and intellectually normal. About 25% of these children will have a family history of febrile seizures.
Who is the treatment team?
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Specialists, such as neurologists or developmental pediatricians, are rarely involved in the management of these children, which is very different than children who have seizures without fever.
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Brain studies such as magnetic resonance imaging or computed tomography scanning and electroencephalogram are generally not indicated and if done, are typically normal in children with simple febrile seizures.
What are some elements of a Care Plan for febrile seizures?
How to keep a child safe during a seizure—the emergency Care Plan
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Call 911.
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Keep calm. You cannot stop a seizure once it has started. Let the seizure run its course. Do not try to revive the child.
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Ease the child to the floor and loosen his clothing.
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Try to remove any hard, sharp, or hot objects that might injure the child. You may place a cushion or soft item under his head.
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Turn the child to his side, so that saliva can flow out of his mouth.
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Protect the breathing passages by tilting the head back a bit and adjusting the jaw forward in the sniffing position.
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Do not put anything in the child’s mouth. He may bite his tongue, but that will not stop him from breathing.
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Try to time the seizure and note what parts of the body are involved. This information may be helpful to physicians caring for the child afterward.
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After the seizure, let him rest if he is sleeping.
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Contact his parents/guardians.
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If the child wakes after the seizure, he may be groggy or irritable, and just needs comfort measures.
What adaptations may be needed?
Medications
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The Care Plan should include having fever-reducing medications such as acetaminophen (eg, Tylenol) or ibuprofen (eg, Motrin, Advil) on hand in case the child develops a fever in the center or school. This medication can be supplied by the parent, but instructions for using the medication should be written out for the program staff by a health care professional.
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Unfortunately, simple medicines to reduce the fever (antipyretics) have not been shown to prevent febrile seizures.
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When a child has a fever, the fever is not an illness. The source of the fever must be identified.
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Some children will have rectal suppositories (eg, rectal diazepam gel) prescribed to be given if the child develops a febrile seizure. These medications can help stop or shorten a seizure, but in some cases, they can slow breathing. If a seizure medication is to be used by program staff, the plan for using the medication should be discussed with the parents and prescribing physician to make sure the plan, including how to monitor and manage any medication side effects, are completely understood.
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Some centers or schools prefer to hold seizure medication and allow emergency medical technicians to administer it if necessary.
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Call parents if the child develops a fever or any other illness symptom.
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Seizures often scare people who do not know about them but usually will not harm the child who has one. A febrile seizure doesn’t cause brain damage.
What should be considered an emergency?
Call emergency medical services/911 if
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The seizure lasts longer than 10 minutes.
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The child has a series of short seizures.
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The child is injured during the seizure.
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This is the child’s first seizure.
What types of training or policies are advised?
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Medication administration
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CPR
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Emergency preparation
What are some resources?
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National Institute of Neurological Disorders and Stroke, 800/352-9424,www.ninds.nih.gov
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Epilepsy Foundation, 800/332-1000,www.epilepsyfoundation.org
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.