Febrile Seizures in Children: Meaning, Symptoms, Causes & Treatment

One moment, your child is fine. The next, they’re completely stiff. Their eyes roll back, their arms and legs begin to twitch, and your whole world just freezes.

Seizures are one of the scariest things a parent can go through. But before you get too worried, here is the good news: in case it was a febrile seizure, your kid is probably going to be completely fine.

Of all the seizure types, febrile are the most common in children, affecting 2 to 5% of kids from 6 months to 5 years old. These seizures are a result of fever and are unrelated to epilepsy or brain injury. Most kids recover quickly without any lasting issues.

This article will provide you with a full understanding of febrile seizures, their symptoms, what you should do, and when to seek emergency help, all in a language that parents can understand.

Please note that this article is for informational purposes only. Always consult your pediatrician after any seizure episode, especially a first occurrence.

What Are Febrile Seizures?

Febrile seizure means a seizure that happens because of a high body temperature, generally over 38°C (100.4°F), in young children. “Febrile” just means related to fever.

It’s not epilepsy, brain injury, or neurological disease that causes them. They are caused by a temporary state of sensitivity of a young child’s brain to temperature changes, which is why they usually appear during viral or bacterial infections such as the flu, ear infections, roseola, or throat infections.

Most importantly, febrile seizures don’t cause any brain damage. The American Academy of Pediatrics (AAP) states that simple febrile seizures don’t affect a child’s brain development, intelligence, or behavior in the long run.

Two Types of Febrile Seizures: Simple vs Complex

Depending upon the symptoms and duration of seizure febrile sseizure can be categorised in to different types: 

Simple Febrile Seizure

• Most common type (90%+ of cases)
• Lasts less than 15 minutes
• Whole body involved
• Only one seizure within 24 hours
• Recovery is rapid
• No complications

Complex Febrile Seizure

• Not so common
• Duration exceeds 15 minutes
• May involve only one side of the body
• Repetition of seizure within 24 hours
• Child could be confused
• Medical attention more urgent

If you do not know whether your child had a simple or complex seizure, your doctor will make the assessment based on the duration, the type of seizure, and the time it takes for the child to recover.

Also Read: Common Baby Skin Problems and Their Treatments

Recognising the Symptoms

Febrile seizures can be extremely scary to look at. Here is what you might see:

Twitching of the entire bodyJerking movements of the limbsBody becoming rigidEyes rolling up to the ceilingLoss of consciousnessSlow or irregular breathingNo responseSevere foaming at the mouthSkin being pale or blue brieflyDrowsiness after the seizure

Usually, febrile seizures come to an end on their own within 1-5 minutes. After the seizure, it is common for your child to be tired and somewhat disoriented. This is called the post-ictal period.

What Causes Febrile Seizures?

Main Cause: Rapid Temperature Increase

It is not necessarily a very high temperature that will lead to the seizures, it is more often the rate of increase of fever which is the culprit. Fever going up very quickly from normal to 39 degrees Celsius could be more likely to cause the seizure than a slow increase to 40 degrees Celsius.

Typical Infections Associated with Febrile Seizures

• Influenza (flu), one of the most frequent causes
• Roseola, a viral illness that is most common among toddlers
• Ear infections (otitis media)
• Strep throat and tonsillitis
• Various respiratory viruses and lung infections
• Urinary tract infections

More factors

• Family history: Kids whose parents or siblings have had febrile seizures are at higher risk
• Age: Most frequent from 12, 18 months when the brain is going through fast growth
• Immature nervous system: Young brains are generally more reactive to temperature changes
• Post-vaccination fever: Mild fever following certain immunizations (e.g., MMR) may lead to febrile seizure in rare cases, this shouldn’t be a reason to skip vaccinations

Also Read: Why Vaccines Are Important for Children

What to Do During a Febrile Seizure: Step-by-Step

Try to remain as calm as you can. Most seizures end on their own within 5 minutes and there is usually nothing that needs to be done. Your priority is safety while the seizure is taking place.

These are some good practices to do as a safe first aid steps:

• Put your child on their side (recovery position), this will help prevent choking if there is vomiting
• Tidy up the place, get rid of all sharp, pointy or anything that could do harm
• Loose any tight clothing, particularly the ones around the neck and chest
• Track how long the seizure lasts, start timing when the seizure starts
• Don’t leave your kid alone, observe the breathing and keep up the company
• When the convulsion finishes, get your child back to normal, they might be a bit dazed, sleepy, or scared. It is all right.

Never do these – things during a seizure:

• Don’t put anything in your kid’s mouth, this is a common misconception and it can result in injury
• Don’t restrain your child or hold them down forcibly
• Don’t give food, water, or medicine while the seizure is going on
• Don’t shake the child or try to wake them up
• Only give CPR if the child becomes unresponsive and stops breathing after the seizure

When to Call Emergency Services Immediately

Most febrile seizures are short-lived and go away by themselves. However, you should call emergency services or take your child to the nearest emergency room if

If any of the following cases apply, call 911 immediately:

• Seizure exceeding 5 minutes
• Child is unresponsive or turns blue after the seizure
• Child fails to wake up or regain consciousness after the seizure
• Two seizures within 24 hours
• Stiff neck, light sensitivity, severe headache in your child (possible meningitis symptoms)
• First-ever seizure of your child, evaluation is a must
• Unilateral weakness after the seizure

Whenever you are unsure, make the call. It’s better to be checked and reassured than to wait.

How Doctors Diagnose Febrile Seizures

The doctor can usually figure out the reason for the seizure just by talking to you about your child’s health and giving a quick physical.

They will only call for tests if the seizure seems strange or there are signs that your kid might have a problem with the brain or the nervous system. For example, they might do an EEG or a lumbar puncture if the child has a fever, stiff neck, and headache.

Briefly, here is what additional testing may be done:

• If the seizure was a complex one or lasted longer than usual
• If there are signs pointing to meningitis or another infection of the nervous system (neck stiffness, really bad headache)
• If the child is less than 1 year old and hasn’t had all their vaccines
• If the child had been on antibiotics before the seizure (which can hide the meningitis symptoms)

Treatment: What Your Doctor Will Do

Treatment plans usually depend upon the severity of conditions:

For Simple Febrile Seizures

In most cases, simple febrile seizures do not require any specific anti-seizure medication. The doctor will focus on treating the fever and the infection:

• Using medicines to control fever: Paracetamol (acetaminophen) or ibuprofen as per the child’s age and weight
• Taking care of the infection: If it’s bacterial, antibiotics; if it’s viral, antivirals, the doctor makes the choice
• Keeping the child hydrated and rested: Comfort is the key

Importantly, routine anticonvulsant (anti-seizure) medications are not recommended for simple febrile seizures, as per current AAP guidelines. The side effects of these medications outweigh the benefits for an otherwise healthy child.

For Complex or Prolonged Seizures

If a seizure lasts 5 minutes or more, emergency medications may be used in a hospital setting, such as rectal diazepam, intranasal midazolam, or IV lorazepam. Your child will be monitored and evaluated by a specialist.

Will it happen again? 

• 1 in 3: children who have one febrile seizure will have another
• Upto 50%: recurrance rate in children under 12 month at first seizure
• Age 5: most children outgrow febrile seizure completely by this age

Can Febrile Seizures Be Prevented?

There is no foolproof method for preventing febrile seizures. Even if you manage the fever right away, the seizure might still happen, because in many cases, it is the pace of the temperature increase that causes the seizure rather than the highest temperature itself.

Here are a few things that may help in addition to supporting your child’s overall health:

• When your child is ill, check their temperature regularly and start fever control measures early
• Vaccinations must be kept up-to-date as some vaccines protect against infections that lead to high fevers (like meningitis and flu)
• Drinking plenty of fluids to stay hydrated during the fever
• Avoid excessive bundling of a child with fever, clothes should be light, room temperature comfortable
• Regular pediatric visits for early identification and treatment of infections leading to fever

Note: Medicines for fever relief such as paracetamol can make your child feel better but they cannot guarantee to prevent a febrile seizure. Keep to the dosage but don’t rely on these medicines as a form of protection.

Conclusion:

It is scary to see your child having a seizure. A lot of parents say it’s one of the most horrible moments of their lives, even after the doctors kept reassuring them that everything was fine. Your feelings are perfectly legitimate.

You might experience the following after the seizure:

• Will deeply worry every time your kid gets a fever
• Have trouble sleeping or be filled with dread all the time
• Feel the need to keep constantly checking on your child
• Fear it happening again when you are not there

Be honest with your pediatrician regarding your anxieties. Ask them to provide you with a clear plan of action, just knowing what to do if it happens again usually gives most parents a great sense of relief. Your feelings are normal. Don’t be ashamed to seek for help. Support is out there.