A seizure is a sudden flurry of electrical activity in the brain that affects how a person feels or acts. Some people have very mild seizures with no loss of consciousness, where only one small part of the body shakes, like the hand. Other people may have very sever seizures, losing consciousness, dropping to the ground and shaking violently. The latter can be very scary to witness. Still others may stare off into space and not be aware of their surroundings. The child or person having the seizure does not remember it afterwards.
When seizures occur more than once or over and over, it may indicate the ongoing condition epilepsy.
Some kids under 5 years old have febrile seizures, which can occur when they develop a medium or high fever — usually above 100.4° F (38° C). While terrifying to parents, these seizures are usually brief and rarely cause any life-threatening, serious, or long-term problems, unless the fever is associated with a serious infection, such as meningitis.
During a febrile seizure, a child's whole body may convulse, shake, and twitch, eyes may roll, and he or she may moan or become unconscious. This type of seizure is usually over in a few minutes, but in rare cases can last up to 15 minutes.
Febrile seizures stop on their own, while the fever continues until it is treated. Some kids might feel sleepy afterwards; others feel no lingering effects.
No one knows why febrile seizures occur, although evidence suggests that they're linked to certain viruses. Kids with a family history of febrile seizures are more likely to have one, and about 35% of kids who have had one seizure will experience another (usually within the first 1-2 years of the first). Kids who are younger (under 15 months) when they have their first febrile seizure are also at higher risk for a future febrile seizure. Most children outgrow having febrile seizures by the time they are 5 years old.
Febrile seizures are not considered epilepsy, and kids who've had a febrile seizure only have a slightly increased risk for developing epilepsy compared to the general population.
What to do during a febrile seizure
If your child has a febrile seizure, stay calm and:
- Make sure your child is in a safe place and cannot fall down or hit something hard.
- Lay your child on his or her side to prevent choking.
- Watch for signs of breathing difficulty, including any color change in your child's face.
- If the seizure lasts more than several minutes, or your child turns blue, it may be a more serious type of seizure — call 911 right away.
- It's also important to know what you should not do during a febrile seizure:
- Do not try to hold or restrain your child.
- Do not put anything in your child's mouth.
- Do not try to give your child fever-reducing medicine.
- Do not try to put your child into cool or lukewarm water to cool off.
- If your child is vomiting or has a lot of saliva coming from the mouth, turn their head to the side to prevent choking.
When the seizure is over, call your doctor for an evaluation to determine the cause of the fever. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. But if your child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting, the doctor may recommend some testing.
Get help right away from a health care provider if:
- The seizure lasts more than several minutes
- Your child is having trouble breathing or is changing color
- Your child looks ill
- Your child looks lethargic and is not responding normally
- Your child looks dehydrated
Febrile seizures can be scary to witness but remember that they're fairly common, are not usually a symptom of serious illness, and in most cases don't lead to other health problems. If you have any questions or concerns, talk with your doctor.
In kids under 5 years old, breath-holding spells can cause seizures. These aren't the spells where kids hold their breath to get back at their parents. Instead, these occur in kids who have an exaggerated reflex so that when they're hurt or emotionally upset they stop taking in a breath (with or without crying hard first). They then turn blue or very pale, often pass out, and might have a full convulsion-like seizure in which the body is stiff and they're unconscious and not breathing. While scary to parents, these spells usually stop on their own and the kids almost never suffer any harm from them. Call your doctor if such a spell occurs.
In older kids, about 10% or more have standard fainting spells (also called syncope), which is often associated with a brief seizure or seizure-like spell. A child may stiffen or even twitch or convulse a few times. Fortunately, this rarely indicates epilepsy. Most kids recover very quickly (seconds to minutes) and don't require specialized treatment.
Because there are so many causes of seizures, your doctor will begin with a very thorough medical history, including a family history. Your doctor will also ask for details about the seizure, when it occurred, how long is lasted, how many your child may have had, how your child acted during the seizure and any other details that can help him or her understand the cause.
Depending on the events surrounding your child’s seizure or seizures, your doctor will run testing, which may include any or all of the following:
- Complete neurological evaluation
- Outpatient EEGs
- Inpatient video EEG monitoring in our EMU
- Neuroimaging which may encompass an MRI, MRS, PET, iMRI and 3-D modeling
- Evaluations of speech and auditory processing