What to do if your child has a febrile seizure

May 2, 2017 Ednea A Simon, MD

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Fever-related illnesses are a part of growing up and developing a healthy immune system. But what a frightening experience when a child has a seizure during a fever! Some parents might immediately think a brain infection is the cause. This possibility needs to be ruled out, and for this reason a child needs immediate medical attention. Fortunately, in many cases, the child has simply had a febrile seizure.

What is a febrile seizure?

A febrile seizure occurs with a fever and without an infection in the brain or an associated metabolic condition. Although these seizures occur with a fever, the increase in body temperature may not be evident until after the seizure.
Febrile seizures occur in normally developing children 6 months to 5 years old. They are not harmful or necessarily associated with an increased risk of epilepsy or future cognitive problems. The key factor is the peak temperature of the fever. Low-grade fevers are less likely to cause a seizure than a sudden peak in body temperature.

How do I know my child had only a febrile seizure and nothing more serious?

A simple febrile seizure, the most benign form, is defined as a generalized tonic clonic seizure, also known as grand mal seizure. These seizures last less than 15 minutes. Sometimes, however, a child has a complex febrile seizure, which involves only one part or one side of the body, the presence of multiple seizures over a short period of time or a seizure that lasts more than 15 minutes.

A physical exam and sometimes additional tests are done to determine the cause of the fever and seizure. Children under a year old will usually have a spinal tap because signs and symptoms of bacterial meningitis may be minimal or absent at this age. Children with a pre-existing neurologic condition may have an increased risk of seizures triggered by fever. These are called symptomatic febrile seizures.

Is my child at risk for more seizures in the future?

A family history of febrile seizures, a low peak temperature during a seizure and a seizure that occurs when a child is younger than 18 months can increase the risk of recurrence. Overall, about one-third of children will experience another seizure.

What should I do if my child has febrile seizures?

Seek immediate medical attention if it is your child’s first febrile seizure. Medications to control fever are recommended when a child is sick. These medications will prevent rapid increases in body temperature, but they won’t necessarily prevent a febrile seizure. This is because some children will have a seizure at the onset of a fever before any increase in body temperature.

It is very important to stay calm if your child has a seizure. Place your child on a flat, protected surface, and turn your child on his or her side to avoid respiratory difficulties. Time the seizure; if it lasts more than three to five minutes or if your child has breathing problems, call 911 for immediate help.

Does my child need to take anti-epileptic medication to avoid seizures?

Children with febrile seizures do not have epilepsy, so they do not need to take long-term antiepileptic medication. 
Your doctor may prescribe a medication to be used to stop a prolonged seizure. Most seizures last less than five minutes and do not require medication. Medication is particularly useful if you live in a remote area or if you are traveling and immediate medical assistance is not available. You can discuss this with your doctor.

Should my child see a neurologist after a febrile seizure?

It is very important to follow up with your pediatrician after your child has a fever-related seizure. If your child has a complex febrile seizure or any previous neurologic problems, a neurologic evaluation and additional investigations are advised to determine the risk of another seizure.

Could children be genetically predisposed to febrile seizures?

Genetic influences and a family history increase the risk of first-time and recurring febrile seizures. In particular, some families carry a mutation in the sodium channel gene that predisposes them to febrile seizures and epilepsy in the future. A neurologist can evaluate this possibility and order a test to diagnose this condition. 

A genetic cause should be considered, particularly for a child who has had:
  • Multiple febrile seizures that start before the child is 1 year old
  • Febrile seizures that affect only one side of the body
  • Prolonged febrile seizures, usually called status epilepticus
  • Prior febrile seizures and developmental regression
These findings may suggest a diagnosis of Dravet syndrome, which requires specific treatment.

We can help

A pediatric neurologist can evaluate a child with febrile seizures to determine if additional tests are needed and to discuss future risks.  

To schedule an appointment, call the Swedish Pediatric Neuroscience Center at 206-215-1440.

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