A Comprehensive Guide to Febrile Seizures: Causes, Actions, & Emergencies

As a parent or caregiver, witnessing your child experience a fever-induced seizure can be one of the most terrifying moments of your life. While they are generally not harmful, fever-related seizures, also known as febrile seizures, are alarming and can lead to intense fear and confusion. Understanding what causes febrile seizures, how to respond effectively, and when to seek emergency medical help is critical in these situations.

In this comprehensive guide, we’ll explore febrile seizures, the causes, types, and risk factors, along with eight essential steps you should take if your child experiences one. We’ll also detail when it’s necessary to call 9-1-1, ensuring that you are prepared to handle this situation calmly and effectively.

What Is a Febrile Seizure?

A febrile seizure is a convulsion in young children that’s triggered by a sudden spike in body temperature, usually as a result of an infection. While they can look severe, febrile seizures are often harmless and do not cause long-term effects. These seizures occur most commonly in children between the ages of 6 months and 5 years. According to the National Institute of Neurological Disorders and Stroke (NINDS), around 2 to 5% of children will experience at least one febrile seizure.

Febrile seizures are generally classified into two categories:

• Simple febrile seizures: These seizures last less than 15 minutes, involve the entire body, and do not recur within a 24-hour period.
• Complex febrile seizures: These seizures last longer than 15 minutes, may involve only one part of the body, and may recur multiple times within a 24-hour period.

The exact cause of febrile seizures is not fully understood, but they are believed to be related to how the brain reacts to a sudden fever. Genetics also play a role; children with a family history of febrile seizures are more likely to experience them.

Common Causes of Fever Leading to Febrile Seizures

• Viral infections like the flu, roseola, or respiratory infections.
• Bacterial infections such as ear infections or tonsillitis.
• Post-immunization fevers (particularly after the MMR vaccine).
• Sudden fever onset where body temperature rises rapidly above 100.4°F (38°C).

Now, let’s break down what you should do when your child has a fever-induced seizure.

8 Essential Steps to Take During a Febrile Seizure

1. Stay Calm The first and most important thing to remember is to stay calm. Although febrile seizures can be distressing, it’s crucial for you to remain composed. Keeping a level head will help you think clearly and take the necessary steps to ensure your child’s safety.
2. Move Your Child to a Safe Place If your child is standing or sitting when the seizure begins, gently place them on the ground or another flat surface. Ensure they are away from any hard or sharp objects that could cause injury during the convulsions.
   • Lay them on their side to help keep their airway clear and prevent choking.
   • Cushion their head to protect them from hitting the ground.
3. Time the Seizure While it may feel like the seizure is lasting forever, most febrile seizures last only a minute or two. Use a clock or your phone to time the seizure. If the seizure lasts more than 5 minutes, you should seek immediate medical help by calling 9-1-1.
4. Do Not Hold Them Down or Restrict Movements It’s important not to try to stop the convulsions by holding your child down. Doing so can lead to injury or make the situation more frightening for both you and your child. Allow the seizure to run its course while ensuring the child is in a safe position.
5. Do Not Put Anything in Their Mouth A common misconception is that a child can swallow their tongue during a seizure, but this is not possible. Avoid putting anything in your child’s mouth, including food, drink, or objects like a spoon, as this can lead to choking or injury.
6. Check for Breathing Issues Once the seizure ends, check to ensure your child is breathing normally. It’s common for children to be disoriented or sleepy after a seizure, but they should be able to breathe without difficulty. If you notice any signs of breathing problems (e.g., bluish lips or gasping for air), call 9-1-1 immediately.
7. Monitor Their Condition Post-Seizure After the seizure stops, your child may be drowsy, confused, or irritable. This postictal phase can last anywhere from a few minutes to an hour. During this time, allow them to rest and recover. Stay by their side and monitor their breathing, alertness, and overall condition.
8. Seek Medical Attention Even if the seizure is brief and your child seems to recover well, it’s still important to contact your pediatrician to discuss the next steps. They may want to evaluate your child to determine the cause of the fever and decide whether any further testing is necessary.

When to Call 9-1-1

While most febrile seizures are harmless and stop on their own, there are specific instances where immediate medical attention is required. Call 9-1-1 or seek emergency help if:

• The seizure lasts longer than 5 minutes.
• Your child has difficulty breathing or their skin turns blue.
• The seizure is accompanied by vomiting, stiff neck, or unresponsiveness after the seizure ends.
• Your child is under 6 months of age and has a seizure.
• The seizure involves only one side of the body or affects one limb specifically (this may indicate a complex febrile seizure).
• The child does not wake up or respond normally once the seizure has ended.
• Your child has multiple seizures within a 24-hour period.

Understanding Febrile Seizures: What Comes Next?

If your child experiences a febrile seizure, it’s natural to feel overwhelmed with questions about what the future holds. Here’s what you should know about post-seizure care and prevention:

• Most children recover fully from febrile seizures and do not develop epilepsy or other seizure disorders. In fact, the risk of developing epilepsy after a febrile seizure is low, around 2-4%.
• Recurrence is common: Approximately one-third of children who have a febrile seizure will experience another one, often within the next year. The likelihood of recurrence is higher if:
  • The first febrile seizure occurred before 15 months of age.
  • A family history of febrile seizures is present.
  • The fever was relatively low at the time of the seizure.
• Reducing the risk of future seizures: While it’s impossible to prevent every febrile seizure, you can take steps to reduce the risk. When your child has a fever, monitor their temperature closely and administer antipyretic medications (like acetaminophen or ibuprofen) to help lower the fever. However, studies show that fever-reducing medications do not always prevent febrile seizures from occurring.

Febrile Seizure Treatment

Febrile seizures usually don’t require treatment beyond managing the fever and ensuring your child is comfortable. However, in certain cases, your pediatrician may recommend additional steps:

• Antipyretics: Medications like ibuprofen or acetaminophen can be given to manage the fever. Keep in mind that these medications only treat the fever, not the seizure itself.
• Anticonvulsant medication: For children who have complex febrile seizures or a family history of epilepsy, your pediatrician may discuss anticonvulsant medications to reduce the risk of recurrent seizures.
• Testing: In some cases, additional tests like a lumbar puncture or an EEG may be recommended, especially if the seizure occurred in a very young child, lasted longer than usual, or involved focal (one-sided) symptoms.

Conclusion: Navigating Febrile Seizures with Confidence

Experiencing your child’s febrile seizure can feel overwhelming, but knowing what steps to take—and when to seek emergency help—can make all the difference. By staying calm, following the essential steps outlined above, and being prepared to call 9-1-1 if necessary, you can navigate this medical situation with confidence and care.

Always remember, while febrile seizures are often harmless, it’s essential to keep your child’s healthcare provider informed and involved in their care. Your pediatrician can guide you through the next steps, whether it’s managing a current fever or understanding the likelihood of future seizures.