Febrile Seizures (Convulsions with Fever)
Febrile convulsions are seizures triggered by high fever. They are the most common type of convulsion (occurring in 4% of children) and in general are harmless. The children are usually between 6 months and 4 years of age. Most first seizures occur by 2 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 1 to 10 minutes without any treatment.
Most of these children (60%) have just one febrile seizure in a lifetime. The other 40% have two or three recurrences over the years. Febrile seizures usually stop occurring by 5 or 6 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 the usual dose of acetaminophen and encourage cool fluids.
Protect Your Child’s Airway
If your child has anything in the mouth, clear it with a finger to prevent choking. Place your child on the side or abdomen (face down) to help drain secretions. If the child vomits, help clear the 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 the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger. Don’t try to hold the tongue. While children may rarely bite the tongue during a convulsion, they can’t “swallow the tongue.”
Call our office immediately:
- After the seizure has stopped.
- If the febrile convulsion continues for more than 10 minutes.
If you are told to drive to our office, keep the fever down during the drive. Dress your child lightly and continue sponging if necessary. (WARNING: Prolonged seizures caused by persistent fever have been caused by bundling up sick infants during a long drive.)
If your physician decides the seizure can be treated safely at home, the following information may help you.
Oral Fever-reducing Medicines
If your physician agrees, give your child acetaminophen at the regular dosage for your child’s age every 4 hours for the next 48 hours (or longer if the fever persists). Awaken him once during the night for the medicine.
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.
The only way to completely prevent future febrile convulsions is for your child to take an anticonvulsant medicine on a daily basis until 3 or 4 years of age. Since anticonvulsants have side effects and febrile seizures are generally harmless, anticonvulsants are rarely prescribed any more unless your child has other neurologic problems. Your physician will discuss this decision with you.
Try to control fever more closely than is necessary for children without febrile seizures. Begin acetaminophen at the first sign of any fever (temperature over 100°F [37.8°C]). Febrile convulsions usually occur during the first day of an illness. Because fever is common after DPT immunizations, begin acetaminophen in the physician’s office when your child is immunized and continue it for at least 24 hours. If your child has a fever at bedtime, awaken him once during the night to give acetaminophen. Avoid covering your child with more than one blanket because bundling during sleep can push the temperature up 1 or 2 extra degrees.
Call our office immediately:
- Another seizure occurs.
- The neck becomes stiff.
- Your child becomes confused or delirious.
- Your child becomes difficult to awaken.
- You feel your child is getting worse.