When a child experiences a seizure due to a high-grade fever, it can be frightening and difficult to watch. Seizures that occur in infants and children during episodes of fever are called febrile seizures. Most febrile seizures end without needing treatment and rarely contribute to any other health problems. Having febrile seizures does not necessarily mean that a child has epilepsy or will suffer from brain damage. However, it is important to stay calm and ensure the child is treated with proper first aid to prevent any accidents or injuries.

Understanding Seizures

Seizures or convulsions occur in individuals when the normal connections between the cells in the brains do not function properly and results in an “electrical storm.”

The risk of an individual experiencing a seizure depends on the threshold of the brain to withstand excess electrical activity. In infants and children, high fevers can cause this threshold to decrease, potentially resulting in febrile seizures.

Fortunately, there is no evidence of seizures causing brain damage or affecting the intellectual capability in children.

High Fever and Seizures

Although the exact cause of febrile seizures is unknown, the following risk factors have been identified:

• Fever higher than 102 degrees Fahrenheit

   

• Family history of febrile seizures

   

• Daycare attendance

   

• Developmental delays

   

• Use of alcohol or tobacco by mother while pregnant with child

   

• Complications at birth requiring hospitalization longer than 28 days

During a seizure episode, the child may lose consciousness and shake with movement of the limbs on both sides of the body. Some children may become rigid and have twitches only in one portion (arm or leg) or one side of the body. The seizure stops on its own, but the fever will last until it is treated.

There are two types of febrile seizures.

• Simple febrile seizures are the more common type of febrile seizure and involve the whole body. They last for less than 15 minutes and do not recur within 24 hours.

   

• Complex seizures last for more than 15 minutes, are confined to one part of the body, and recur more than once in 24 hours. Complex febrile seizures occur when there are serious underlying disease conditions such as infection of the lining of the brain or spinal cord. Tests such as an electroencephalogram (EEG) test that measures brain activity may be necessary in children who suffer from complex febrile seizures.

Parents and caregivers should carefully observe the child during a seizure to prevent him or her from being injured. The child should never be restrained or held during the episode. To prevent choking on vomit or saliva, the child should be placed on his or her side on the floor or another safe surface. Any objects, such as a pacifier, should be removed from the child’s mouth. Do not try to lower a child's fever to stop a febrile seizure, such as by giving medications by mouth or placing the child in a cool tub of water.

If the child struggles to breathing, has a face that changes color due to lack of oxygen, or has a seizure that lasts longer than 10 minutes seek immediate medical attention. 

After the Seizure

Even if a seizure only lasts a few seconds, a doctor should evaluate a child as soon as possible, especially if it is the first seizure a child has experienced.

After every subsequent seizure, the child should be examined by a doctor to determine the cause of fever.

A child needs urgent medical attention if he or she shows signs of stiff neck, extreme lethargy, or vomits excessively after the seizure has stopped. These may be signs of a more serious condition, such as meningitis.

The doctor may perform blood and urine tests to find out the cause of the fever to rule out other disease conditions as the reason for the seizures. The doctor may perform a spinal tap to remove a sample of the cerebrospinal fluid. This test can reveal if there is an infection of the fluid that surrounds the brain and spinal cord that may responsible for the seizures.

The child may need to be hospitalized for observation if he or she experiences prolonged seizures, has a serious infection, or if the source of infection is not easily identifiable.

There is usually no need for medication in children who are prone to febrile seizures.  However, for children with recurrent febrile seizures, the doctor may prescribe a drug called as diazepam whenever the child has fever. The drug can lower the risk of having another seizure. While a majority of children tolerate the medicine well, some children may experience drowsiness, hyperactivity, or lack of coordination.

Use of fever-reducing drugs such as acetaminophen or ibuprofen has not been proven to reduce the risk of a seizure. Also, the use of anticonvulsant drugs such as phenobarbital or valproate is not recommended for the management of febrile seizures due to the risk of side effects.

A child is at risk of recurrent seizures if the first seizure occurs before the age of 15 months or there is a family history of febrile seizures.

The child is also at risk of having recurrent febrile seizures if there was a relatively low fever at the time of the first seizure, brief time duration between fever onset and initial seizure, or there were multiple initial febrile seizures during the same episode.

Risk of Epilepsy

A single seizure does not mean that the child has epilepsy. Even repeated febrile seizures are not considered epilepsy because children may outgrow seizures caused by fever.

However, there is a risk of developing epilepsy for children who have prolonged febrile seizures lasting for more than 15 minutes, seizures that affect only one part of the body, seizures that recur within 24 hours, or associated conditions such as cerebral palsy, delayed development, or other neurological abnormalities.

Conclusion   

Watching a child experience a febrile seizure can be alarming, and the few minutes of the seizure episode may seem like an eternity. Fortunately, febrile seizures are usually not as dangerous as they look. They are usually neither indicative of a serious underlying problem nor do they lead to epilepsy or any other health problems. Ensuring the child is safe during a seizure and following up with a doctor’s visit are key to handling febrile seizures.