Understanding and Managing Seizures Caused by Fever in Children: A Guide for Parents and Caregivers

Febrile seizures (febrile convulsions) are fits that can happen when a child has a fever. They most often happen between the ages of 6 months and 3 years.

It can be frightening and distressing to see your child having a seizure, particularly if it’s their first seizure.

However, these seizures are usually harmless, and almost all children recover afterward.

As a precaution, you may still need to take your child to the nearest hospital or call 999 and ask for an ambulance. See 

Signs of a febrile seizure

A febrile seizure usually lasts for less than 5 minutes. Your child will:

• become stiff, and their arms and legs may begin to twitch,
• lose consciousness, and may wet or soil themselves

They may also be sick and foam at the mouth, and their eyes may roll back.

After the seizure, your child may be sleepy for up to an hour. A straightforward febrile seizure like this will only happen once during your child’s illness.

Occasionally, febrile seizures can last longer than 15 minutes, and symptoms may only affect one area of your child’s body.

These are known as complex febrile seizures. These seizures sometimes happen again within 24 hours or during your child’s illness.

What to do during a febrile seizure

If your child has a febrile seizure, place them in recovery. Stay with your child and try to make a note of how long the seizure lasts.

Cool the infant as fast as possible, remove clothes, Use a cold face cloth, and open windows to reduce the ambient temperature.

Do not put anything into your child’s mouth during a seizure – including medicine – as there’s a slight chance they might bite their tongue.

Take your child to the nearest hospital or call 911 and ask for an ambulance if:

• your child is having a seizure for the first time
• the seizure lasts longer than 5 minutes and shows no signs of stopping
• you suspect another serious illness is causing the seizure – for example, meningitis
• your child is having breathing difficulties

While there’s unlikely, anything seriously wrong, getting your child checked is important.

If your child has had febrile seizures before and the seizure lasts for less than 5 minutes, call a doctor or health professional for advice.

You should also contact a doctor if your child shows signs and symptoms of dehydration (a lack of fluid in the body).

Seeing a doctor

Febrile seizures can often be diagnosed from a description of what happened. It’s unlikely that a doctor will see the seizure happening, so it’s useful to note:

• how long the seizure lasted
• what happened, such as body stiffening, twitching of the face, arms, and legs, staring, and loss of consciousness
• whether your child recovered within 1 hour
• whether they’ve had a seizure before

Further tests, such as a blood or urine test, may be needed if the cause of your child’s illness is unclear.

Getting a urine sample from young children can sometimes be difficult, so it may have to be done in the hospital.

Further testing and observation in the hospital is also usually recommended if your child’s symptoms are unusual or they’re having complex febrile seizures, particularly if they’re younger than 12 months old.

The tests that may be recommended include:

• An electroencephalogram (EEG) measures your child’s electrical brain activity by placing electrodes on their scalp. Unusual patterns of brain activity can sometimes indicate epilepsy.
• A lumbar puncture, where a small cerebrospinal fluid (CSF) sample is removed from the spine for testing. CSF is a clear fluid that surrounds and protects the brain and spinal cord. A lumbar puncture can determine whether your child has an infection of the brain or nervous system.

Causes of febrile seizures

The cause of febrile seizures is unknown, although they’re linked to the start of a high temperature (fever).

There may also be a genetic link to febrile seizures, as the chances of having a seizure are increased if a close family member has a history of them.

In most cases, the child’s high temperature is caused by an infection. Common examples are chickenpox, flu, a middle ear infection, or tonsillitis.  

In rare cases, febrile seizures can happen after a child is vaccinated.

Recurring febrile seizures

About 1 in 3 children with febrile seizures will have another seizure during a subsequent infection. This often happens within a year of the first one.

Recurrence is more likely if:

• the first febrile seizure happened before your child was 18 months old
• there’s a history of seizures or epilepsy in your family
• before having their first seizure, your child had a fever that lasted less than an hour or their temperature was under 40C
• your child previously had a complex febrile seizure (more than one seizure during their illness)
• your child attends a daycare nursery – this increases their chances of developing common childhood infections, such as the flu or chickenpox

It’s not recommended that your child is given a prescription for regular medicines to prevent further febrile seizures. This is because the adverse side effects of many medicines outweigh any risks of the seizures themselves.

Research has shown that using medicines to control high temperatures is not likely to prevent further febrile seizures.

However, a specialist may sometimes recommend medicine such as midazolam or diazepam to treat seizures when they happen.

Children who’ve had a febrile seizure after a routine vaccination – which is very rare – are no longer at risk of having another seizure than children who had one because of illness.

Complications of febrile seizures

Febrile seizures have been linked to an increased risk of epilepsy.

Many parents worry that if their child has one or more febrile seizures, they’ll develop epilepsy as they age. Epilepsy is a condition where a person has repeated seizures without a fever.

While it’s true that children who have a history of febrile seizures have an increased risk of developing epilepsy, it should be stressed that the risk is still small.

It’s estimated that children with a history of simple febrile seizures have a 1 in 50 chance of developing epilepsy in later life.

Children with a history of complex febrile seizures have a 1 in 20 chance of developing epilepsy in later life.

People who have not had febrile seizures have around a 1 to 2 in 100 chance of developing epilepsy.

Conclusion

In conclusion, febrile seizures can be a frightening experience for parents and caregivers, but it is important to understand that they are relatively common and usually not harmful. 

Monitoring a child’s fever and taking steps to manage it, such as using fever-reducing medication and keeping the child cool and hydrated, can reduce the risk of febrile seizures. 

If a seizure occurs, staying calm and seeking necessary medical attention is important. With proper understanding and management, febrile seizures can be effectively treated and minimized in their impact on a child’s health and well-being.