Febrile seizures

Download this Patient Note in PDF format

VOL 110 / NO 2 / AUGUST 2001 / POSTGRADUATE MEDICINE

A high body temperature sometimes causes seizures (also called convulsions) in infants and young children. These are known as febrile seizures or fever seizures. They can be very frightening, but they usually are not dangerous unless the child falls or has something in his or her mouth that could cause choking.

Most children who have febrile seizures have rectal temperatures above 102°F. The seizures often occur shortly after the fever starts. During a typical febrile seizure, the child loses consciousness and the arms and legs begin to shake. Less often, the child becomes rigid or has twitches in only one part of the body, such as one arm or leg, or on only the right or the left side.

Most febrile seizures last a minute or two, although some can be as brief as a few seconds. Seizures that last more than 10 minutes may be more serious and require medical attention. Children prone to febrile seizures are not considered to have epilepsy, which is associated with recurrent seizures that are not triggered by fever.

How common are these seizures?
About 1 in every 25 children will have at least one febrile seizure, and about one third of these children will have more. Febrile seizures usually occur between the ages of 6 months and 5 years and are particularly common in toddlers. Children rarely have their first febrile seizure before age 6 months or after age 3 years. The older a child is when the first seizure occurs, the lower the risk that more seizures will follow.

Are these seizures harmful?
Although febrile seizures can be very frightening, they are harmless in most cases. These seizures do not damage the brain or nervous system. During a seizure, there is a small chance that the child may be injured by falling or may choke on food or saliva. Paying attention to the environment and keeping things away from the child's mouth can help avoid these hazards.

There is no evidence that febrile seizures lead to more complicated seizure disorders, such as epilepsy. When epilepsy does occur after febrile seizures (which is very rare), the first seizures tend to be different from the usual febrile type. They generally last a longer time, recur within 24 hours, and affect only part of the body.

How is a febrile seizure treated?
Parents, teachers, or caregivers should try to stay calm, maintain a safe environment, and carefully observe the child. To prevent accidental injury, the child should be placed on a protected surface, such as the floor or ground. A youngster should not be held or restrained during a convulsion.

To prevent choking, the child should be positioned on his or her side. When possible, the adult in charge should gently remove all objects from the child's mouth. Nothing should ever be placed in the child's mouth during a convulsion. Such objects can break and then could obstruct the airway.

If a seizure lasts longer than 10 minutes, it is a good idea to call 911 or, when appropriate, to take the child to the nearest medical facility. Once the seizure has ended, the child's physician should be called for advice about whether more treatment is needed. This is especially important if the child shows symptoms of stiff neck, extreme tiredness, or vomiting. The doctor usually will want to treat the cause of the fever to prevent future problems.

What to do if a child has a febrile seizure

The most important part of helping a child who is having a seizure is to stay calm yourself. Most seizures stop on their own within a few minutes. Nonetheless, witnessing a seizure in an infant or young child can be very frightening, and you may feel powerless and want to rush in and do something. Here are some ideas for how you might help the youngster.

• Create a safe environment for the child on the floor or ground.
• Place the child on his or her side to prevent choking on saliva.
• Don't restrain the child's movements during the seizure.
• Don't put anything in the child's mouth. (There is no danger that the child will swallow his or her tongue.)
• Talk to the child softly, letting him or her know you are there to help.
• Keep an eye on the clock. If the seizure lasts more than 10 minutes, call 911 or, if appropriate, take the child to the nearest hospital or emergency care center.

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste