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mamanya Dafi
Understand Febrile Seizures
By Carole A. Stashwick, M.D.
Your 18-month-old had a runny nose all morning, ate
almost no lunch, and is a little fussy. As you lay him
down for a nap, his body stiffens, he stares ahead,
and his arms and legs jerk 20 or 30 times. His face is
pale, and he doesn't respond to your voice.
Your son is having a seizure. Just before you call
emergency services, the jerking stops, and he cries
and
clings to you. Then he rests quietly in your arms. The
seizure lasted only about 2 minutes, but you are
shaking with terror. You notice your son is very warm,
and the thermometer measures 103 degrees under his
arm. The nurse in your pediatrician's office asks you
to bring the baby to the office now. After an
evaluation, the pediatrician diagnoses a febrile
seizure.
About 3 to 5 percent of children -- 1 out of every 20
to 30 children -- experience a febrile (fever)
seizure. Simple febrile seizures are brief convulsions
that usually appear without warning and last less than
15
minutes, after which the child will seem fairly
normal. By definition, a febrile seizure involves
fever -- usually in the range of 103 degrees or higher
-- although fever may not be apparent until after the
seizure has occurred.
Simple febrile seizures occur between the ages of 6
months and 5 years, more often in boys than girls.
About one-third of children who have a febrile seizure
will have at least one more before the age of 5. The
younger a child is at his first febrile seizure, the
more likely he is to have another. Febrile seizures
also tend to run in families.
Parents are understandably very frightened by a
seizure. Roll your child on his side so that he won't
inhale vomit or saliva; keep him from falling or
hurting himself during the seizure, and wait for it to
end. Do not force a spoon or any object between his
teeth to keep him from biting his cheek or tongue. If
the seizure doesn't stop within about 10 minutes, call
your local emergency services (usually 911) for
further advice.
The child with a fever seizure should be evaluated in
the pediatrician's office, or in an acute pediatric
center or emergency department after hours. The
pediatrician will reduce the fever by undressing the
child and by giving medication, usually acetaminophen
or ibuprofen. The doctor may also test
blood or urine to determine the cause of the fever. If
the baby is younger than 12 months or if meningitis
(infection of the spinal fluid) is suspected, a spinal
tap may be performed. An antibiotic will be prescribed
if an ear or urine infection is discovered.
Seizure medications are not usually required for
febrile seizures -- the seizure has almost always
ended by the time the paramedics arrive or by the time
the child arrives at the doctor's office or emergency
room. Tests such as electroencephalogram or brain CT
or MRI scan have not been shown to be helpful in
evaluating a simple febrile seizure. Seizure
medications are not usually prescribed to prevent
recurrence of simple febrile seizures because they
have been associated with behavior and learning
problems later in childhood.
You can help prevent febrile seizures from recurring
during the same illness by giving your child the
recommended dose of fever medication regularly every
4 to 6 hours. Don't overdress him. Sponging a child
with a very high fever (over 104 to 105 degrees) in
the bath, in addition to giving fever medications, can
reduce fever. Do not place a child in cold water or
rub his skin with alcohol in an attempt to reduce the
fever.
Complex febrile seizures are those that last longer
than 15 minutes, require seizure medication to stop,
or recur very frequently. A child with a complex
febrile seizure may be hospitalized for further
evaluation, such as a brain CT scan and/or EEG, and
consultation with a neurologist.
Febrile seizures make parents and grandparents very
anxious. Simple febrile seizures do not cause brain
damage, however, and most children do quite well. Only
about 3 percent of children who have febrile seizures
will develop epilepsy (seizures not related to fever)
later in life. Your pediatrician can provide more
information to help you understand febrile seizures
and to prevent recurrences.
__________________________________________________
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