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Febrile seizures

A febrile seizure is a convulsion in a child triggered by a fever .

Alternative Names

Seizure - fever induced

Causes

A febrile seizure can be very frightening for any parent or caregiver. Most of the time, a febrile seizure does not cause any harm and the child usually does not have a more serious long-term health problem.

Febrile seizures occur most often in otherwise healthy children between ages 9 months and 5 years. Toddlers are most commonly affected. Febrile seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and may not occur when the fever is highest. Ear infections, a cold or viral illness may trigger a febrile seizure.

Symptoms

A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is often followed by a brief period of drowsiness or confusion.

Symptoms may include any of the following:

  • Sudden tightening (contraction) of muscles on both sides of a child's body. The muscle tightening may last for several seconds or longer.
  • The child may cry or moan.
  • If standing, the child will fall.
  • The child may vomit or bite their tongue.
  • Sometimes, children do not breathe and may begin to turn blue.
  • The child's body may then begin to jerk rhythmically. The child will not respond to the parent's voice.
  • Urine may be passed.

A seizure lasting longer than 15 minutes, is in just one part of the body, or occurs again during the same illness is not a normal febrile seizure.

The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). A grand mal seizure involves the entire body. In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis (bacterial infection of the covering of the brain and spinal cord).

Exams and Tests

With a typical febrile seizure, the examination usually is normal, other than symptoms of the illness causing the fever. Often, the child will not need a full seizure workup, which includes an EEG , head CT, and lumbar puncture (spinal tap ).

Further testing may be needed if the child:

  • Is younger than 9 months or older than 5 years.
  • Has a brain, nerve, or developmental disorder.
  • Had the seizure in only one part of the body.
  • Had the seizure last longer than 15 minutes.
  • Had more than one febrile seizure in 24 hours.
  • Has abnormal findings when examined.

Treatment

During the seizure, take the following measures to keep the child safe:

  • Do not restrain the child or try to stop the seizure movements.
  • Lay the child on the ground in a safe area. Clear the area of furniture or other sharp objects.
  • Slide a blanket under the child if the floor is hard.
  • Move the child only if they are in a dangerous location.
  • Loosen tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
  • If the child vomits or if saliva and mucus build up in the mouth, turn the child to the side or on the stomach. This is also important if it looks like the tongue is getting in the way of breathing.
  • Do not force anything into the child's mouth to prevent biting the tongue. This increases the risk of injury.

Focus your attention on bringing the fever down:

  • Insert an acetaminophen suppository (if you have some) into the child's rectum.
  • Do not give anything by mouth.
  • Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol can make the fever worse.
  • After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Meningitis can cause a few cases of febrile seizures. It should always be considered, especially in children younger than 1 year old, or in children who still look ill when the fever comes down.

Outlook (Prognosis)

The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, a decrease in IQ, or learning problems.

Most children outgrow febrile seizures by age 5.

Few children have more than three febrile seizures in their lifetime. The number of febrile seizures is not related to future risk of epilepsy.

Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These seizures most often do not appear like a typical febrile seizure.

When to Contact a Medical Professional

Children should see a doctor as soon as possible after their first febrile seizure.

If the seizure lasts several minutes, call 911 to have an ambulance bring your child to the hospital.

If the seizure ends quickly, drive the child to an emergency room when it is over.

Take your child to the doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.

Call or see the health care provider if other symptoms occur before or after the seizure, such as:

It is normal for children to sleep or be drowsy or confused for a short time right after a seizure.

Prevention

Because febrile seizures can be the first sign of illness, it is often not possible to prevent them. A febrile seizure does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. However, no medication is completely effective in preventing febrile seizures.

References

American Academy of Pediatrics, Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures. Febrile seizures: clinical practice guideline for the long-term management of the child with simple febrile seizures. Pediatrics. 2008;121:1281-1286.

Mick NW. Pediatric fever. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Elsevier Mosby; 2013:chap 167.

Mikati MA. Febrile seizures. In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 586.1.

Updated: 2/26/2014

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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