Febrile seizures are a common condition, occurring in about 2-4% of children aged 6 months to 5 years. As children grow older, the chance of febrile seizures decreases. ‘Febrile seizures’ occur suddenly, appear severe, and can be frightening to observers. However, this condition rarely causes brain damage if appropriate initial first aid is provided. Febrile seizures mostly occur in children who have a rapid rise in fever.
Therefore, symptoms usually appear within the first 24 hours of fever. This condition is diagnosed based on symptoms and physical examination to rule out other more serious causes, such as central nervous system infections, electrolyte imbalances, or other genetic disorders, as these conditions can cause additional disabilities.
Signs and Symptoms
- The child will be unconscious, have a vacant stare, stiffen arms and legs, and have convulsions either in the whole body or in parts.
- Some children may foam at the mouth, have blue lips, blue fingertips and toes, and may lose control of bowel and bladder.
*What parents should know initially is that most seizures in children stop on their own within 5 minutes.
First Aid
- Stay calm and do not panic.
- Place the patient lying on their side in a safe area (away from dangerous objects or sharp items).
- Avoid putting any objects such as sticks, cloth scraps, spoons, or even the helper’s fingers into the child’s mouth, as this may cause injury to the child (teeth may break and block the airway or push the tongue to block the airway) or injury to the helper (the unconscious patient may bite the helper’s fingers causing injury).
- Then try to find another helper to contact and send the child to the hospital.
*Some may have heard that seizures can cause tongue biting. In reality, the chance of tongue biting during a seizure is very low. Injuries may occur from teeth hitting the side of the tongue but are usually not severe. Inserting objects into the patient’s mouth can cause more harm than good during assistance.*
Examination and Treatment
Upon arrival at a healthcare facility, the doctor will take a history regarding the duration of the fever, the cause of the fever, the characteristics or pattern of the seizure, and the duration of the seizure. Therefore, witnesses should try to describe the event to the doctor, as some seizure types require further investigation. The doctor will then perform a physical examination and may order additional laboratory tests if there is suspicion of infection or abnormalities in the patient’s fluid and electrolyte balance.
Electroencephalography (EEG)
EEG is not necessary for the first febrile seizure. It is usually performed in cases of prolonged seizures, unusual seizure patterns, specific syndromes, or in patients with multiple febrile seizures.
Lumbar Puncture
Considered in cases suspected of central nervous system infection or in patients under 1 year old with febrile seizures, as symptoms of central nervous system infection in young children may be unclear.
Radiological Examination (CT/MRI brain)
Usually performed if EEG shows abnormalities or if physical examination suggests possible brain abnormalities.
Facts and Frequently Asked Questions
- Most febrile seizures in children are brief and do not cause intellectual or developmental problems.
- There is a chance of recurrent seizures if risk factors are present, such as first seizure occurring under 1 year of age, a direct family history of febrile seizures, or prolonged seizures.
- Children who have had febrile seizures should have their fever reduced promptly by cooling and taking antipyretics (paracetamol) before being taken to the hospital, as untreated fever may lead to recurrent febrile seizures.
- When a child has a high fever and seizures, they should be cared for in a pediatric intensive care unit, where a specialized pediatric team, nurses, and experts work together to provide close care with complete, ready-to-use, and modern equipment, available 24 hours a day.
- Generally, this condition does not require anticonvulsant medication unless there are specific indications, which should be discussed and decided jointly between the parents and the treating physician regarding the benefits and risks of anticonvulsants.
