A febrile convulsion
is caused by a fever higher than 38 °C, without any other associated neurological disease.
Age of occurrence of febrile convulsions
Convulsions affect less than 5% of children with a fever. Febrile convulsions are more common in children under the age of 5, with a peak between 6 months and 5 years. 90% of febrile convulsions are benign.
A febrile convulsion is like an epileptic seizure
. It occurs when a child is unwell and has a high temperature, for example during a flu like illness or an ear infection.
The majority of these attacks are simple and benign.
Features of a Febrile convulsion
The attack is generalised.
- Duration: less than 10 to 15 minutes
- No neurologic deficit: normal neurological examination
- No reoccurrence in 24 hours
- Absence of brain injury
- Normal psychomotor development
Usually no investigations are needed - that is if the child has fully recovered from the seizure
(happy, alert and smiling) and the cause of the fever is clear.
Further investigation may be required if recovery is slow, as there may be a more serious cause of the convulsion - for example meningitis
An EEG (electroencephalogram) will be requested when repeated convulsions occur, or if the first convulsion is unusual and more than 20 minutes.
The risk of experiencing another febrile convulsive fit after a first episode of convulsions is of 20 to 40%.
Complex febrile convulsions
Some attacks last longer and can be suggestive of more severe problems, especially if they occur in a child of less than 6 months or in a child over 5 years old.
A complex convulsion can account for 10% of convulsions.
In this case the diagnosis is in question and the risk of a reoccurrence is higher than at the time of the first convulsion.
- The attacks are longer than 15 minutes
- Focused fits, focusing on only half the body
- Impaired movement after the fit
- The neurological examination is abnormal
- A family history of epilepsy
A febrile convulsion can sometimes reveal a neurological disease
- Child less than 1 year old
- Frequent feverish episodes
- Family history of epilepsy and febrile seizures
- First febrile focal complex seizure, recurring within 24 hours and accompanied by a neurologic problem.
Treatment of a febrile convulsion
- Stay with your child and place in the recovery position.
- Maintain the airway - checking that there is nothing in the mouth.
- Make the child lie down on his side and turn his head to the side.
Treat the fever
- Remove the child's clothes to just a vest
- Give paracetamol
- Avoid too many layers of clothing or bedding
- Air the room
- Encourage fluids, keeping the child hydrated.
- A cool bath is no longer recommended as part of any emergency measure.
Treatment of a febrile convulsion attack
Treat the fever with paracetamol: antipyretics such as paracetamol on their own do not reduce the risk of a recurrent febrile convulsion. Repeated or prolonged attacks may be treated with rectal diazepam. This medicine acts quickly usually within 2 minutes.
Preventive treatment of the febrile convulsions
Preventative treatment is given in extreme cases and the indications for treatment are:
- Complex febrile convulsions
- Repeated simple febrile convulsions
They vary according to the child's history and doctor treating the child.
2 types of treatment can be use:
- Rectal Diazepam to use during the appearance of a high fever.
- Sometimes an epileptic medication is given as daily dose for 1 or 2 years
Hospitalisation is sometimes necessary
Hospitalisation is advised:
- To treat any infection causing the fever; for example meningitis
- A severe convulsion or one that is prolonged and not responding to medication
- Any unusual signs or symptoms and when a neurological cause is suspected as the cause of the convulsion.