What are non-febrile seizures (epilepsy)?
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Seizures are sudden abnormal events or episodes that happen because of a problem with the way brain cells communicate through electrical signals.
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During a seizure, some brain cells send abnormal and exaggerated electrical signals that stop other cells from working properly.
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A seizure causes the patient to experience temporary disturbances in awareness or consciousness, movement, sensation, and behavior.
How common are they?
Seizures represent the most common neurologic disorder in children. About 1% of all children have a type of non-febrile seizure disorder, or epilepsy.
What are some characteristics of children with non-febrile seizures?
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Different types of seizures represent different parts of brain involvement.
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Generalized (formerly known also asgrand mal ) seizures occur when the whole brain and whole body are involved. A child may stiffen and shake all over in a rhythmic or biphasictonic (stiff)clonic (jerking) fashion. Children may fall to the ground and hurt themselves during a seizure. Sometimes they lose control of their bladder or bowels. Most seizures last no more than 3 or 4 minutes. Children do not respond to you during these seizures and may be very confused and sleepy afterward for hours. -
Absence (known aspetit mal ) seizures look like staring spells. These children may stop and stare for a few seconds in the middle of whatever they are doing. The child who is having an absence seizure will not be able to respond to you while it is happening and will have no memory of the episode afterward. There may be lip smacking or rhythmic eye blinking while the child is not responsive. -
Partial seizures can be simple or complex because only a part of the brain is involved.-
In a
simple partial seizure, a child may do many things such as shake one part of his body or see, hear, or smell something that is not there. The child is not confused during these episodes, although he may be frightened. -
During a
complex partial seizure, a child may be confused or have a distortion of consciousness. During these episodes, children may behave in a strange way or may have strange words or actions such as hand rubbing, lip smacking, or swallowing. They are confused and sleepy after the seizure is over.
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Many children with seizures have normal intelligence; some have developmental delays.
Who is the treatment team?
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A pediatric neurologist often directs the medical management of children with seizures.
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Children with developmental delays may receive speech, occupational, or physical therapy.
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Children younger than 3 years may receive these therapies through
early intervention services. These therapists may suggest activities or exercises that could be helpful in the child’s Care Plan.
What are some elements of a Care Plan for non-febrile seizures?
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Call 911.
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Activate emergency medical services (EMS).
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Emergency plans—how to keep a child safe during a seizure
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Keep calm. You cannot stop a seizure once it has started. Let the seizure run its course and say comforting, soothing things to the child.
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Ease the child to the floor and loosen her 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 her head.
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Turn the child to her side, so that saliva can flow out of her mouth.
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Do not put anything in the child’s mouth. She may bite her tongue, but that will not stop her from breathing,
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After the seizure, let her rest if she is sleeping. Contact her parents/guardians.
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If the child wakes after the seizure, she may be groggy or irritable and just needs comfort measures.
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What adaptations may be needed?
Medications
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Many children with non-febrile seizures take medication for their seizure disorder, and medication administration may be part of their Care Plan. These medications are often called
anticonvulsants; there are many different types.-
Talk to parents/guardians about the child’s particular anticonvulsant therapy and the side effects that might be associated with the medication, especially those affecting learning and attention.
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Most anticonvulsants suppress seizures, but the medication may not be able to completely eliminate all seizure activity.
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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 by the program staff with the parents and prescribing physician. This helps to ensure that the plan, including how to monitor and manage any medication side effects, is 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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Many seizure medications have interactions with other types of medications, so make sure to check before giving a child on anticonvulsants any over-the-counter medications.
Dietary considerations
Some children with seizures may be on a special diet known as the ketogenic diet. Parents/guardians or a dietitian can give you details on the diet if necessary.
Physical environment
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Communicate with the child’s parents/guardians and doctor about the individual type of seizure, medications, and emergency plan. Update this on a regular basis, preferably after the child has his neurology appointments.
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Children may be more prone to seizures when they are ill. Unusual irritability, lethargy, or fevers are cues to alert the child’s parents/guardians.
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Children may have triggers to seizures, such as flashing lights, lack of sleep, or eating poorly. Discuss seizure triggers with the child’s parents/guardians.
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Seizures often scare people who do not know about them, but usually they will not harm the child who has one.
What should be considered an emergency?
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Call parents/guardians for
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Change in the child’s activity or behavior
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Increased staring or single muscle jerks
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Fever
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Call EMS/911 for seizures unless staff is trained and comfortable with handling seizure. In that case, the child’s Care Plan should specify when to call 911 for a seizure.
What types of training or policies are advised?
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CPR
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First aid
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Medication administration
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Policy on seizures and emergencies
What are some resources?
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.