A baby in a red jumper holding a baby doll.

Febrile Convulsions

Many years ago I had a near death experience with my toddler.  Well  it felt like a near death experience  but it turned out that even though, he turned blue, looked like he had stopped breathing and had gone all limp, he was  apparently  not  in  danger.  I, on the other hand was in grave danger of becoming a hopeless wreck of a mother incapable of doing anything but crying down the phone to the emergency services. My son was having a febrile convulsion and I am ashamed to say that I panicked big time. Now of course, 3 children on and having run a first aid training company for the past 15 years I am much wiser.

But at the time, I had not heard about a febrile convulsion something which I now know is relatively common in young children.  It can happen when a young child develops a high temperature (38 degrees or above) and tends  to occur with common illnesses such as ear infections, coughs, colds, flu and other viral infections.   My son had a cold, he had a temperature and it was winter and I probably wrapped him up a bit too tightly.

Watching a child have a seizure, particularly if they have no previous history of seizures, can be very frightening and distressing.  But most febrile convulsions are harmless, do not pose a threat to the child’s health and do not cause brain damage.

When we cover this topic  on our paediatric first aid courses there are many questions – so here are a few of them.

How common are they?

1 in 30 children will have a febrile convulsion at one time or another. This usually happens between the ages of 6 months and 6 years.  A child is four times more likely to have a febrile convulsion if either parent was affected when young.  Children of parents with epilepsy are also at a slightly higher risk.  For some reason, boys are more likely to be affected than girls.

What Do They Look Like?

  • The child usually loses consciousness.
  • Their muscles may stiffen or jerk and twitch.
  • They can lose control of their bladder or bowel, wetting or soiling themselves.
  • They may go red or blue in the face and their eyes can roll upwards.
  • The convulsion may last for several minutes.
  • Then the movements stop, and the child regains consciousness but remains sleepy or irritated afterwards.

What should I do?

Although very upsetting, try to keep calm and remember that a febrile convulsion is unlikely to cause any harm or damage.  Remove any objects/furniture out of the child’s reach to avoid injury.  Hold the child in your arms, or lie the child down on a soft surface like a cot or bed, with their head below their body if possible.  Don’t restrain the child or put anything in their mouth, but take off any warm clothing and loosen anything tight.  If the child is sucking a dummy, gently remove it.  Don’t try to give anything to eat or drink during the convulsion.  If possible, try to note the length of time the fit lasts, and the type of movements and sounds the child makes.

The child may lose consciousness for a minute or two, but most will come around quickly without any help.  Stay with the child throughout the convulsion, and when it’s over call the doctor (unless it has happened before and the doctor has advised that you do not need to call).  Once the child is fully conscious, try giving infant liquid paracetamol or ibuprofen syrup (if safe to do so) to reduce the child’s temperature.  You can also give the child plenty of cool fluids to drink and dress them in loose, cool clothing.  In the past, common advice thought to help cooling was to sponge with lukewarm water but this is no longer thought to help so is not recommended.  Do not be tempted to wrap up the child in warm clothes or blankets, even if they say they are cold, or appear to be shaking from the cold.

If the child wants to go to sleep, prop them on their side using a rolled up blanket so the child doesn’t roll onto their back.  You may have been given further advice regarding medication if the child has had a previous febrile convulsion.

When to seek emergency help?

If the child is not breathing normally after a convulsion, or if it lasts five minutes or more, you need to get emergency help by dialling 999.  If a child is under the age of one, it is likely your doctor will refer you to your local hospital to investigate the cause of the fever. A blood test, urine and stool samples may be needed to identify the virus or bacteria responsible.  Sometimes, a lumbar puncture might be recommended to exclude meningitis.  It is very unlikely that a child with meningitis would present having had a febrile convulsion, but meningitis can be difficult to pick up in babies and it is important to rule it out.  If a child is over the age of one, your doctor may only refer you to a consultant if they are not convinced that the cause of your child’s infection is a virus or cold.

Care after the convulsion

  • Occasionally children who have long convulsions need to be watched in hospital for a while afterwards. This is usually to work out the cause of the fever and watch the course of the child’s illness.
  • The child may be a little cranky for a day or so, but this will pass.
  • Resume the usual routines.
  • Put the child to sleep at the usual time, in his or her own bed. Don’t worry about whether you will hear a convulsion; a bed or cot is a safe place for a convulsion.

Can a febrile convulsion be prevented?

As a convulsion of this kind is caused by a rapid rise in temperature usually at the start of a bacterial or viral illness, the best form of prevention is to keep the child’s temperature down.  Remove any warm clothing and give liquid paracetamol.  However, sometimes it is so fast that you do not have enough notice to do any of the temperature cooling methods.  Unfortunately, other than this, there aren’t any really effective tactics you can use.

While anti-convulsant medication is useful for children who suffer from recurrent convulsions not associated with fever (epilepsy), there is little evidence to suggest that such medication will prevent recurrent febrile convulsions, and the possibility of side effects tends to outweigh the benefits.

Is it epilepsy?

Febrile convulsions are not the same as epilepsy and does not cause brain damage. Many people worry that if the child has one or more febrile seizures, they will develop epilepsy when they get older. Epilepsy is a condition where a person has repeated seizures (fits) without fever.  While it is true that children who have a history of febrile seizures have an increased risk of developing epilepsy, it should be stressed that the risk increase is still quite small; about one per cent of children subsequently develop epilepsy (this is more likely if the child has a longer than normal convulsion, or recurrent seizures in the same illness).
What is the chance of it happening again?

  • If a child is over the age of one when they have their first febrile convulsion, they have around a one in three chance of having more. If it happens before the age of one though, the chance of having another rises to one in two.
  • The length of time that the convulsion lasts is also important. If a first convulsion lasts a long time – rarely, this can be up to 15 minutes – further convulsions are more likely in the future. If a child has repeated long convulsions it may be of benefit to visit a general paediatrician, ask the doctor or emergency department to make this referral.
  • But the good news is that around six or seven out of ten children who have one febrile convulsion never have another.

Looking forward

The vast majority of children, including those who have had several febrile convulsions, will stop having them well before they start school.

What research is being done on febrile seizures?

Scientists are exploring environmental and genetic risk factors that may make children susceptible to febrile seizures and are also working to pinpoint factors that can help predict which children are likely to have recurrent or long-lasting febrile seizures.

Helpful tip:

Stock your secure medicine cupboard with ibuprofen (if no contraindications) and paracetamol syrup for children.  Make sure they are in date and that you don’t run out of them.  Regarding thermometers Great Ormond Street Hospital state the following:

It can be difficult to judge whether a child is just a bit hot or running a temperature. Measuring your child’s temperature accurately will help you decide what to do next. We do not recommend using old-fashioned mercury and glass thermometers for children, as there is always a risk that they will break. You can buy strip or digital thermometers quite cheaply in most pharmacies.” 

Digital thermometers come with disposable ear probe covers which can be brought from local pharmacies or cheaply in bulk from online retailers.

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