Febrile seizures

My 19 month old daughter had a febrile seizure for the first time and really scared my husband and me. I am worried now that every time she gets a fever she is going to have a seizure. So instead of trying not to be the worry wart mom and let a temperature do it's work instead of running to the doctor, I feel like the minute it hit's 99.9, I'm going to be a nervous wreck. Is there anything for me to worry about such as brain damage or possible epilepsy later in life? I would like to know the percentage's of children that have febrile seizures and then the percentage of them that end up with epilepsy.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

A febrile seizure is a convulsion that is brought on by having a fever. And although these seizures are felt to be for the most part benign, they can be one of the most horrifying things to witness in your child. It occurs in children in ages ranging from about 6 months of age to 5 years. It is estimated febrile seizures occur in 3-5% of children. The cause of these seizures is not known, however, it appears to be related to the rate of rise in temperature rather than the actual height of fever, itself. In other words, the child that rapidly gets a fever to 104 degrees seems to be more at risk of having a seizure than the child who arrives at this temperature more slowly. In addition, there appears to be a genetic cause as well because these seizures tend to run in families.

This type of seizure looks like seizures from other causes. The child loses consciousness, the eyes may roll back in the head, and there is usually stiffening or rhythmic jerking of the arms and legs. This lasts no more than 10 minutes and stops without treatment. The child is usually sleepy after the seizure but she usually gets back to normal (except for feeling bad from whatever is causing the fever) within 60 minutes.

Once a child has a febrile seizure, the risk of having another ranges anywhere from 25-50%. There are only two medications \[phenobarbital and diazepam (Valium)\] which when given during a illness causing fever have been proven to reduce the risk of a recurrent febrile seizure, however, the side effects of this medication may be great. Thus, many pediatricians are hesitant to implement these medications.

Children who were without neurologic problems before the febrile seizure and have only seizures associated with fever do not have an increased risk of mental retardation. The incidence of epilepsy in the general population for children is about 0.5%. Those who have febrile seizures have about a two-fold increased risk of getting epilepsy. In other words, of those that have febrile seizures, 1% of them will go on to develop epilepsy. However, some have argued that the studies which have shown this apparent increase in risk includes those children that probably had a prior seizure disorder in the first place. Currently, there is no evidence to suggest that the use of medications to prevent febrile seizures decreases the chance of developing epilepsy.

Justine, I can certainly understand how you are going to be a "nervous wreck" the next time your daughter starts to get a fever. It's easy for us doctors to stand by and tell you that there is little to worry about, but when it's your child, it's hard not to be frightened. Quite honestly, she has a good chance of having another seizure with fever. Based upon her age at which she had her first (and only) febrile seizure, she has about a 35% chance of having another one when she has fever. On the other hand (and the one I'd prefer to emphasize), she has a 65% of never having another febrile seizure.

Therefore, I think it's good to keep in mind a few things for the next time she has fever:

  1. Treat fever the same as you would for any other illness (Tylenol and lukewarm sponge baths).
  2. It is not a bad idea to use acetaminophen (Tylenol) as early as you can when she is having fever. Make sure you are using the correct dose, and don't use it any more often than every 4 hours.
  3. Many parents feel guilty because they feel they could have given the Tylenol earlier, and thus could have avoided the seizure. Don't kick yourself. Studies have shown that even when using acetaminophen around the clock during febrile illnesses, it does not decrease the chance of having another febrile seizure.

Should your child have another seizure:

  1. Stay calm!
  2. Check her to make sure she is breathing without difficulty
  3. Turn her on her side. This will help prevent her from choking on saliva or vomit.
  4. Safety for your child is your biggest concern.
    • Remove sharp objects from around your child
    • Do not put anything in her mouth
    • Do not try to restrain moving arm or legs
    • You may support her head in your arms or a pillow
  5. Try to note how long the seizure lasts
  6. Try to note what types of movements are occuring and if it affects the whole body or just certain parts.
  7. Notify your doctor

Good luck to you.

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