Febrile Seizures - Convulsions with Fever
Febrile seizures are convulsions triggered by high fever. They are the most common type of convulsion (occurring in 4% of children) and in general are harmless. Children who experience febrile seizures are usually between six months and four years. Most first seizures occur by two years of age. The average temperature at which they occur is 104° F (40° C). The fever itself can be caused by an infection in any part of the body. Each febrile seizure usually lasts one to ten minutes without any treatment.
Most of these children (60%) have just one febrile seizure in a lifetime. The other 40% have one to three recurrences over the next few years. Febrile seizures usually stop occurring by five to six years of age. They do not cause any brain damage; however, a few children (3%) will later have seizures without fever.
Reduce the Fever. Bringing your child's fever down as quickly as possible will shorten the seizure. Remove your child's clothing and apply cold washcloths to the face and neck. Sponge the rest of the body with cool water. As the water evaporates, your child's temperature will fall. When the seizure is over and your child is awake, give him the usual dose of acetaminophen or ibuprofen. Encourage cool fluids.
Protect Your Child's Airway. If your child has anything visible in his mouth, clear it with a finger to prevent choking. Place your child on his side or abdomen (face down) to help drain secretions. If your child vomits, help clear his mouth. Use a suction bulb if available. If your child's breathing becomes noisy, pull the jaw and chin forward.
Common Mistakes in First Aid of Convulsions. During the seizure, don't try to restrain your child or stop the seizure movements. Once started, the seizure will run its course no matter what you do. Don't try to force anything into your child's mouth. This is unnecessary and can cut his mouth, injure a tooth, cause vomiting, or result in a serious bit of your finger. Don't try to hold his tongue. Although children may rarely bite the tongue during a convulsion, they can't "swallow the tongue."
Emergencies. Call (911) IMMEDIATELY if the febrile convulsion continues more than five minutes.
Driving In. If you are told to drive to a medical facility, keep the fever down during the drive. Dress your child lightly and continue applying a cold washcloth to the forehead. (Warning: Prolonged seizures caused by persistent fever have been caused by bundling up sick infants during a long drive.)
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If your physician decides the seizure can be treated safely at home, the following information may help you.
Oral Fever-Reducing Medicines. Febrile convulsions usually occur during the first day of an illness. Try to control fever more closely than is necessary for children who do not have febrile seizures. Begin acetaminophen or ibuprofen at the first sign of any fever (a rectal temperature over 100.4° F [38° C]) and give it continuously for the first 48 hours of the illness. If your child has a fever at bedtime, awaken her once during the night to give the fever medicine.
Because fever is common after diphtheria-tetanuspertussis (DTP) immunizations, begin acetaminophen or ibuprofen in the physician's office when your child is immunized and continue it for at least 24 hours.
Fever-Reducing Suppositories. Have some acetaminophen suppositories on hand in case your child ever has another febrile seizure (same dosage as oral medicine). These suppositories may be kept in a refrigerator at the pharmacy, so you may have to ask for them.
Light Covers or Clothing. Avoid covering your child with more than one blanket. Bundling during sleep can push the temperature up one to two extra degrees.
Lots of Fluids. Keep your child well hydrated by offering plenty of fluids.
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The only way to completely prevent future febrile convulsions is for your child to take an anticonvulsant medicine on a daily basis until three to four years of age. Since anticonvulsants have side effects and febrile seizures are generally harmless, anticonvulsants are rarely prescribed unless your child has other neurologic problems. Your physician will discuss this decision with you.
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Call Your Pediatrician's Office Immediately if
- Your child has a febrile convulsion.
- The neck becomes stiff.
- Your child becomes confused or delirious.
- Your child becomes difficult to awaken.
- Your child starts to act very sick.
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