Febrile Convulsions

By Dr Megan Yap - PaediatricianGeneral14 May 2018

So today we are going to discuss a phenomenon that we see in kids’ emergency departments ALL THE TIME.  Given that in the last 2-3 days the weather has gotten cold and we flu season is literally JUST around the corner, I thought this might be a good topic to cover for today.  FEBRILE CONVULSIONS.

A seizure (or a fit) that happens when a child has a fever is called a febrile convulsion. It has to be one of the most frightening things that a parent can watch and unfortunately occur fairly commonly (in about 3-4% of healthy children).

Thankfully MOST febrile convulsions stop without needing any intervention after less than 2 minutes (although can range from a few seconds to 15 minutes or more) and most commonly have no long term consequences.

I worked and trained in children’s emergency (in the old Royal Children’s Hospital in Brisbane), and I was taught that they occurred in children between 5 months and 5 years of age (depending on the source of your information this range can vary slightly).

 

What is a fever?

A fever is when child’s temperature is 38oC or higher (see my previous blog post on fever at http://www.kids-health.guru/fever-in-children/ ).  It is a normal response of the body to infection (eg viral or bacterial) and is usually harmless, and in fact is thought to help the body to fight the infection.

What does a febrile convulsion look like?

Seizures of any kind are really scary for parents to witness, and febrile convulsions are no exception. Often you may not even know your child is sick, because the fever comes on so quickly.  Signs and symptoms can include:

  • Falling to the floor (and losing consciousness/being unresponsive)
  • Jerking or twitching of the arms and legs
  • Eyes rolling back in the head
  • A change in colour (becoming pale or blue)
  • Difficulty breathing
  • Foaming at the mouth

 

Who gets them?

It is not really known why febrile convulsions occur, but children generally are more susceptible to convulsions than adults and that they tend to run in families (that is, if there is a family history of febrile convulsions, kids are more likely to have one). About a third of kids who have one febrile convulsion, will have another one within around 1-2 years of the first. Some children will only every have one in their lifetime.  There is no way to predict which children will be affected.

The younger a child is when they have their first febrile seizure, the higher their risk of having another one (The Royal Children’s Hospital clinical guideline suggests a recurrence risk of 50% in children under 1 year of age who have their first febrile seizure, dropping to 30% by 2 years of age).

 

How to prevent febrile convulsions

It is not always possible to prevent febrile seizures as they can come on very rapidly. If your child is miserable with their fever you can

  • Give them paracetamol (Panadol) or ibuprofen (Nurofen) to make them feel better or to relieve pain, but this has NOT been shown to prevent seizures from occurring.
  • Avoid overdressing or overwrapping them
  • Do NOT give a cold bath/shower or sponging as this can cool the child too quickly and cause a seizure to come on.

 

If your child has a fit

What to do

  • Try to stay calm
  • Note the time that the seizure started (and then stopped)
  • Make sure that your child is on a safe surface where they cannot fall, and clear away anything that they might hurt themselves on (eg power cords etc)
  • Roll your child onto their side to prevent choking (this allows saliva to drain out of the mouth rather than pool in the airway)
  • If the seizure lasts more than 5 minutes or if your child turns blue, dial 000 for an ambulance
  • Take your child to see your doctor as soon as possible.

What NOT to do:

  • Do not try to restrain the child
  • Do not try to wake them up/shake them
  • Do not put ANYTHING into the child’s mouth

 

Does this mean my child has epilepsy?

No. A febrile convulsion is NOT epilepsy.  However, the risk of epilepsy (seizures without fever) is increased in children who:

  • Have a family history of epilepsy
  • Have other neurodevelopmental problems
  • Have unusual (“atypical”) febrile convulsions
    • That is ones that
      • are prolonged (go for longer than 15 minutes)
      • have jerking or twitching that affects only one side or one part of the body (that is a “focal” seizure)
      • take longer than an hour to recover
      • when more than one seizure occurs within 24 hours

Children who have NONE of these risk factors have the same risk of later epilepsy as the general population (approximately 1%).

Children who have 1 of the above risk factors have a 2% risk of later developing epilepsy, and those who have MORE than 1 risk factor have a 10% chance.

 

What should happen after the seizure?

  • Your child might take up to 30 minutes or more to wake up properly after a febrile seizure.
  • Once the seizure has stopped, the aim of getting medical attention is to determine the cause of the fever (eg tonsillitis, ear infection, chest infection, urinary tract infection etc). Where a focus of the fever is easily identified (eg a snotty nose), blood tests and other invasive investigations do not need to be performed.
  • Appropriate treatment for the infection – eg antibiotics if bacterial, nothing if viral
  • In a child less than 5-6 months of age, more serious infections need to be considered (eg meningitis), and also in children who are not up to date with their immunisations – so in these cases the doctor may order further investigations.

 

Reassurance

  • Mostly, long term anti-seizure medicines are not needed, except in rare situations where the child has frequent and recurring fits
  • Short fits do not cause brain damage… in fact, even long fits rarely ever cause real harm.
  • Seizures get less frequent as children get older, and most kids grow out of their febrile convulsions by age 5-6 years.
  • Even kids who have recurrent febrile convulsions normally grow up well with no permanent or long term damage from their fits.

 

I hope that you don’t have the misfortune of having a child that has febrile convulsions, but if you do… now you know what to expect, what to do and what not to do.

 

Until next time, stay well,

xx Dr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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