Febrile seizures in young children often triggered by high fever
The 11-month-old had seemed fine earlier in the day and went to bed without making a fuss. A little while later, her mom quietly tiptoed into the sleeping infant's room only to find the baby convulsing in her crib with limbs jerking and eyes rolling back.
The mother kept her wits about her and immediately called 911. The seizure stopped without medication, and paramedics quickly transported the girl to the local emergency room for further evaluation. By the time she arrived at the ER triage station, the baby's temperature was nearly 103.
The little patient was given a thorough physical exam, and lab tests were sent off to try to pinpoint the source of the fever. As the evening wore on, the temperature gradually dropped, and the child perked up and began to act more like her normal self.
She was discharged from the ER with a diagnosis of febrile seizure and her parents were given instructions regarding close observation and aggressive fever management. Not surprisingly, mom and dad did not sleep much the rest of the night.
I saw the infant for a recheck the next day, and while she was still feverish and a bit clingy, she really looked pretty good. She became fever-free three days later, and on the fourth day, mom called the office to report that the child had broken out in an impressive body rash. The story was right for roseola, a common childhood virus that is also a common cause of febrile seizures.
In the event of a febrile seizure, physicians at the National Institutes of Health advise placing the child on the floor to avoid falls, and on his side or stomach to prevent choking. Watch your child closely, but don't attempt to restrain him or put anything in his mouth. Notify your child's physician when you are able.
If the febrile seizure lasts more than 10 minutes or your child appears very ill, bring him to the nearest emergency department for seizure management and further work-up.
According to NIH data, febrile seizures are most often seen in children 6 months to 5 years of age and usually occur at temperatures greater than 102.
These high-fever events are so common that about one in 25 kids will experience at least one febrile seizure in their early years, and of these, more than a third will have future episodes.
Recurrence is more likely in children who experience their first febrile seizure before 15 months of age, or in young ones who seize shortly after their fevers start or seize at lower-than-expected levels of fever.
Frequent febrile illnesses and a strong family history of febrile seizures also raise a child's risk of repeat seizures.
The American Academy of Pediatrics defines simple febrile seizures as seizures that last less than 15 minutes, are generalized (not focal or one-sided), and occur only once in a 24-hour period.
Most kids with simple febrile seizures are not at increased risk of developing epilepsy, but the epilepsy risk does increase for those experiencing their first febrile seizure before 1 year of age, for those with multiple episodes of febrile seizures, and for those with a family history of epilepsy.
Experts at the AAP have reviewed the use of a variety of anticonvulsants for the treatment of febrile seizures and conclude that. though several of these medications do appear to reduce the risk of febrile seizure recurrence, they are not without their own risks and toxicities. Since simple febrile seizures are considered benign events, the academy does not recommend long-term anticonvulsant drug therapy in these cases.
The AAP also notes that while acetaminophen (Tylenol) and ibuprofen (Motrin) are effective fever reducers and can help make a sick child more comfortable, they have not been shown to prevent febrile seizures.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.