Febrile seizures Health Article

Treatment

During the seizure, leave your child on the floor. You may want to slide a blanket under him if the floor is hard. Move him only if he is in a dangerous location. Remove objects that may injure him. Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up. If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.

DO NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. DO NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down. Inserting an acetaminophen suppository into the child's rectum is a great first step, if you have some. DO NOT try to give anything by mouth. Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse. After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Expectations (prognosis)

Most children outgrow febrile seizures by age 5.

A small number of children who have had a febrile seizure go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Previous neurologic problems and a family history of epilepsy also make future epilepsy more common. The number of febrile seizures is not related to future epilepsy.

Complications

• An injury from falling down or bumping into objects
• Biting oneself
• Breathing fluid into the lungs, pneumonia
• Injury from prolonged or complicated seizures
• Side effects of medications used to treat and prevent seizures (if prescribed)
• Complications if a serious infection, such as meningitis, caused the fever
• Seizures unrelated to fever

Calling your health care provider

• Children should see a doctor as soon as possible after their first febrile seizure.
• If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital.
• If the seizure ends quickly, drive the child to an emergency room when it is over.
• A child should also see a doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.
• Call or go in if any other symptoms occur before or after the seizure, such as nausea, vomiting, rash, tremors, abnormal movements, problems with coordination, drowsiness, agitation, confusion, or sedation. It is normal for children to sleep or be briefly drowsy or confused immediately following a seizure.

Prevention

Because febrile seizures can occur as the first sign of illness, prevention is often not possible. Neither an initial nor recurrent febrile seizure suggests that your child is not being properly cared for.

Occasionally, a health care provider will prescribe diazepam to prevent or treat recurrent febrile seizures. However, parents must recognize that no medication is completely effective in preventing febrile seizures.

References

Leung AK, Robson WL. Febrile seizures. J Pediatr Health Care. 2007 Jul-Aug;21(4):250-5.

Warren CR. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med. 2003; 41(2): 215-222.

Jankowiak J. Seizures in children with fever: Generally good outcome. Neurology. 2003; 60(2): E1-2.