Febrile Convulsions
Every year children in nursery contract viral illnesses which cause fever and various symptoms – such as diarrhoea, vomiting and respiratory infections – such as ear infections and pneumonia. However for some children the febrile illness will trigger a convulsion – also called a seizure, fit or turn. This article informs parents on the whole issue of febrile convulsions in nursery aged child.
Although alarming, a febrile seizure is not usually dangerous. Full recovery is usual. Most illnesses which cause fever and febrile convulsions are the common coughs, colds, and virus infections which are not usually serious. However, the illness that causes the fever is sometimes serious, for example, pneumonia.
who has a febrile convulsion and what causes them?
Any child, of any age and with any background can, if they have an illness which causes a temperature have a convulsion. However the highest frequency of convulsions is in children aged 6 months to 6 years, the most common ages being 18 months to 3 years. The chances of such a convulsion occurring are increased with a family history of febrile convulsions. About 4 in 100 children have a febrile seizure sometime before their 6th birthday.
what does a febrile convulsion look like?
Febrile seizures are classified into three types, the most frequent group called Simple febrile seizure. These account for 75% of those children with febrile convulsions. This is the most typical type of fit. In this type of fit your child may look hot and flushed and their eyes may appear to roll backwards. They may appear dazed and then become unconscious. The body may go stiff, then generally twitch or shake (convulse). It does not usually last long. It may only be a few seconds, and is unusual for it to last more than five minutes. The child may be sleepy for some minutes afterwards but within an hour or so the child will usually appear a lot better when their temperature has come down. Simple seizures usually only happen once in an illness, and complete recovery is expected.
The second most frequent group is called a Complex febrile seizure –and occurs in 20% of children who have convulsions. The term complex is used because the nature of the seizure has features which make the possibility of further seizures, or in fact another diagnosis possible. These features include:
- The seizure lasts more than 15 minutes
- The seizure recurs within 24 hours or within the same febrile illness
- The child is not fully recovered within one hour. This does not mean the seizure lasts more than an hour, but that it takes more than an hour for the child to look and behave more like their normal self
- The seizure has 'partial or focal features'. This means that rather than a generalised twitch or shaking, only a part of the body may shake. For example, just one arm or just one leg.
All, or any one of these additional features mean the seizure is more complicated then a simple seizure, but outcome in terms of recovery or lack of complications is not really much more than the simple type.
The third type, which is the least common, is called Febrile Status Epilepticus - occurs in less than 5% of those children who have a convulsion. Status means the febrile seizure lasts for longer than 30 minutes.
what first aid should I expect my child's carer to do for a febrile convulsion?
- Note the time it started.
- Lie the child on their side with their head in line with the body or slightly lower (the recovery position).
- Do not put anything into their mouth or shake the child.
When the seizure stops, try to lower the child's temperature to make them more comfortable. To do this take off their clothes (if the room is warm). Then, when they have recovered enough to swallow, give a drink and some paracetamol or ibuprofen.
- Your child should be seen by a doctor as soon as possible after a seizure for a check over to rule out serious illness. However, an ambulance should be called urgently if:
- Your child does not improve quickly once a short (less then 5 minutes) seizure is over.
- A seizure lasts more than five minutes (this includes small twitching movements even if large jerking movements have stopped).
- Another seizure starts soon after the first one stops.
- Your child has difficulty breathing.
- Your child was not fully conscious before the seizure or one hour afterwards.
- You suspect a serious illness is the cause of the fever, for example, if you suspect meningitis.
No treatment is usually needed for the seizure itself if it stops within five minutes but treatment may be needed for the infection causing the fever.
If the seizure continues over 5 minutes, and your child goes to hospital, then treatments may be needed to stop it. A medicine called diazepam can be given into the rectum (back passage) or a medicine called midazolam can be squirted into the side of the mouth. These drugs are absorbed quickly, directly into the bloodstream from within the rectum or mouth, and stop a seizure.
Sometimes the parents of children who are prone to recurrent febrile seizures are taught how to use one of these medicines.
will it happen again?
Most children will only ever have one seizure. About 30% of children who have a febrile seizure, a second seizure occurs with a future feverish illness. In less than 10% of children who have a febrile seizure, three or more further seizures may occur during future feverish illnesses.
A future febrile seizure is more likely if the first occurs in a child younger than 15 months, or if there is a family history of febrile seizures in close relatives (father, mother, sister, brother). With a child of three years old, the chance of a recurrence becomes much less likely. Further convulsions are not common, but it is best to be prepared, by keeping paracetamol handy at all times.
Is a febrile convulsion dangerous? No – the risk of developing a complication is related more to the illness causing the fever, than the convulsion itself. The risk of a child who has had a febrile convulsion developing epilepsy is no greater for children who have had a febrile convulsion than one who has not. Febrile convulsions are not a type of epilepsy.
A small number of children are prone to develop both epilepsy and febrile seizures. So, having a febrile seizure does not cause epilepsy to develop.
can I prevent them?
It may seem logical that if you keep a child's temperature down during a feverish illness it may prevent a febrile seizure. However, there is little scientific evidence to prove that this is so. It is unclear what triggers the seizure. It is possibly some body chemical that is released during certain feverish illnesses rather than the temperature itself. Most children with a high temperature do not have a seizure. However, it is common practice to keep a child cool when they have a feverish illness. This will make them feel more comfortable. Do not put the child in a cool bath, or use a fan as these measures can cause shivering which produces even more heat. If a child appears hot, then the following will help to reduce the temperature:
- Keep the child very lightly dressed, or take all their clothes off if the room is warm.
- Give paracetamol, (for example, Calpol, Disprol, etc), or ibuprofen.
- Give lots of cool drinks.
is treatment needed?
Usually not. In the past numerous drugs have been used to try and reduce further febrile convulsions in children who are prone to them, but no benefit was shown. The underlying illness may need treatment.
should a child who has a febrile convulsion have immunisations?
Yes. Some children develop a fever following immunisation. A very small number of children develop a febrile seizure following an immunisation. However, this is very unlikely to cause any permanent harm, or to happen again after a future immunisation.
For further information speak to your health visitor or local pharmacy. More information is available online :
http://www.cks.nhs.uk/patient_information_leaflet/febrile_convulsions
http://www.patient.co.uk/health/Febrile-Seizure-(Febrile-Convulsion).html
