Febrile Convulsion( The terms Convulsion, fit and seizure are used interchangeably with the same meaning)It is a fairly common condition which parents find very scary. The aim of this article is to help parents deal with this condition with confidence.
Febrile convulsion is fits that happen owing to high temperature(> 38 C or 101 F) in children aged 6 months to 5 years. It is slightly more common in boys than girls. It is usually the first sign of fever.2-5% children go through it before 5 years of age.It usually lasts less than 3 minutes. Although it is often a generalized( involving all four limbs, trunk and head) it can also start in one part of the body and spread. They initially go stiff followed by jerking of all four limbs. During the stiff period, the eyes roll up and may go blue around the mouth.They may also wet or soil themselves. They usually sleep after the episode.
There are 3 types: simple, complex and symptomatic.Simple febrile convulsion (75%)– One fever fit lasting less than 15 minutes, involving all four limbs together.Complex febrile convulsion (20%)– More than one fever fit within an illness, lasts more than 15 minutes and may involve one limb or one side only.Symptomatic (5%)–fever fits caused by meningitis, encephalitis or other infections with brain involvement. The underlying cause needs to be identified and treated.
Risk of Epilepsy:General population – 1 in 100.
Simple febrile convulsion – 1 in 50
Complex febrile convulsion – 1 in 20
The causes of fever:It is most likely to be viral, sometimes bacterial( where antibiotics are indicated) and malaria should be considered too. The infection could be in the throat, ears, chest or in the urine. Sometimes the doctors will be concerned if it is meningitis and will undertake investigations.Temperature, Pulse rate, and Breathing rate will be checked along with blood glucose and then the doctor will examine to find out the focus of infection. You need to have the person who had witnessed the seizure around( to give the history) so that doctor can confirm that it was indeed a febrile fit.Rarely, the doctor may be concerned that these are not fever fits and may undertake investigations ( eg. EEG – brain wave study)Sometimes, chills with fever can be mistaken for fever fits.
Prognosis:Excellent. Simple fever fits do not cause brain damage or long term learning problems(3).There is a 30% risk of further febrile seizures after the first episode.
Of the ones who have the second episode, there is 30% risk for the third episode.
What to do when your child has a fever fit:
1) Lie your child in the lateral position ( ideally to the left)to prevent aspirating anything in the mouth.
2) Wait for seizures to stop. Then let your child sleep which will usually be for ½ hour.
3) If seizures last more than 5 minutes call an ambulance and go to hospital.
4) If it is the first febrile seizure, go to hospital to confirm diagnosis.
5) If it is a repeat episode, manage at home unless unwell.
6) If febrile seizures are prolonged, use medication( buccal midazolam) depending on the advice of your Paediatrician.
1. Rosman NP, Colton T, Labazzo J, et al. A controlled trial of diazepam administered during febrile illnesses to prevent recurrence of febrile seizures. N Engl J Med. Jul 8 1993;329(2):79-84. [Medline].
2. Vestergaard M, Pedersen MG, Ostergaard JR, Pedersen CB, Olsen J, Christensen J. Death in children with febrile seizures: a population-based cohort study. Lancet. Aug 9 2008;372(9637):457-63. [Medline].
3. [Best Evidence] Nørgaard M, Ehrenstein V, Mahon BE, Nielsen GL, Rothman KJ, Sørensen HT. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr. Sep 2009;155(3):404-9. [Medline].