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DESCRIPTION
Fever (febrile) seizures are uncontrolled muscle spasms that can occur in children who have a rapid increase in body temperature. Sometimes you may not even know your child has a fever. Once a fever has reached a high temperature, the risk of a seizure is probably over. The rapid increase in body temperature in a short period of time is the cause of the febrile seizure.
A child having a seizure loses consciousness and then stiffens the muscles and clenches the teeth. Jerking movements of the arms and legs may occur. The child's eyes may roll back. The child may stop breathing for a few seconds and might also vomit, urinate, or pass stools. It is important to protect the child from injury during a seizure.
Fever seizures usually last 1 to 3 minutes. After the seizure, the child may be sleepy. You can let the child sleep, but be watchful. The child also may seem confused after the seizure, but normal behavior and activity level should return within 60 minutes of the seizure.
A seizure is more likely to be a febrile seizure if:
- The seizure happened within 24 hours of the start of a fever.
- The seizure lasted less than 10 minutes.
- The seizure affected the entire body, not just one side.
- The child is between 6 months and 5 years old.
- The child does not have nervous system (neurologic) problems.
- The child has had a febrile seizure before.
Febrile seizures can be frightening to see but usually do not cause any harm and do not cause long-term problems, such as brain damage, mental retardation, or learning problems.
Febrile seizures affect 2% to 4% of children. About 30% of children who have a febrile seizure will have another one, usually within a year of the first seizure. These seizures are not a form of epilepsy.
MoonDragon's Health & Wellness: Fever
FEVER SEIZURE EMERGENCIES
If your child has any of the following symptoms that require emergency treatment? Call 911 or other emergency services immediately.
- Breathing stops for longer than 30 seconds or has moderate to severe difficulty breathing. Before calling 911 or other emergency services, make sure the child is in a safe position on the floor.
DIFFICULTY BREATHING IN CHILDREN
A child who is having severe difficulty breathing may:
- Breathe very fast or grunt with each breath.
- Appear very tired during feeding. Rapid breathing can make a child unable to nurse or take a bottle.
- Use the neck, chest, and abdominal muscles to breathe, causing a "sucking in" between the ribs (retractions).
- Need to sit up and lean forward ("tripod position") or sit with the nose tilted up, as if sniffing the air. The child may fight any attempts to change this position.
- Appear persistently pale, gray, bluish, or mottled (blue and white patches of skin), especially on the tongue, lips, earlobes, and nail beds.
- Act listless, not want to talk or play as usual, or act scared and hyper and be unable to sit still.
A child who is having moderate difficulty breathing may:
- Breathe fast.
- Tire during feeding and may stop often to catch his or her breath. The effort needed for breathing and eating leads to lack of interest in food and decreased food intake.
- Use the abdominal muscles to breathe.
- Have pale to slightly gray or mottled face, hands, and feet while the tongue, gums, and lips remain pink.
A child who is having mild difficulty breathing may:
- Breathe slightly faster than normal.
- Use the abdominal muscles to assist breathing.
- Have normal color of the skin of the face, hands, and feet.
Use the Emergencies and Check Your Symptoms sections to determine if and when your child needs to see a health care professional.
- Seizure lasts longer than 10 minutes, or a second seizure occurs during the same illness.
- Signs of shock are present.
SHOCK IN CHILDREN
Shock is a life-threatening condition. Immediate medical care can make the difference between life and death.
Signs of shock in children may include:
- Cool and clammy skin that looks pale or mottled.
- Shallow, rapid breathing.
- Listlessness and a lack of interest in play or surroundings.
- Difficulty waking from sleep and a lack of response to being touched or spoken to.
- Unusual jerky movements (possible seizure activity caused by shock).
Also, a child in shock has a weak, rapid heart rate and low blood pressure.
Shock may occur in response to a sudden illness or injury. When the body loses too much blood or fluid, the circulatory system cannot get enough blood to the vital organs, and shock results.
- Signs of severe dehydration are present. See Dehydration for more information.
- Signs of heatstroke are present.
- Child is younger than 6 months or older than 5 years.
Note: After calling 911, if the child is not breathing, begin rescue breathing.
CHILD RESCUE BREATHING STEPS
(Ages 1 year to 8 years old)
Rescue breathing for children: For purposes of performing rescue breathing, a child is a person between 1 and 8 years of age. The steps for determining responsiveness, checking and correcting airways, and checking and correcting a child's breathing are essentially the same as for an adult patient, but you should keep the differences in mind:
1. Establish unresponsiveness by shaking the child gently on the shoulder and shouting "Are You Okay?" If the child is unresponsive, and the EMS system has not been notified, activate the EMS system. It is suggested that with a child, you should perform rescue breathing for 1 minute before activating the EMS system if you are on the scene by yourself and EMS has not been notified. Proceed onto step 2 if the child is unresponsive.
2. Correct the airway if closed and open airway by using the head-tilt, chin-lift or jaw-thrust technique. Children are smaller, and you will not have to use as much force to open their airways and tilt their heads. Check the mouth for secretions, vomitus, or solid objects. Correct the airway, if needed, by using finger sweeps or suction to remove foreign substances. Maintain the airway by manually holding it open or by using a oral or nasal airway. Check breathing (look for rising and falling of the patient's chest, listen for the sound of air moving in and out of the patient's nose and mouth, and feel for the movement of air on the side of your face and ear). Continue to look, listen, and feel for 3 to 5 seconds. If child is breathing adequately or resumes breathing, place in recovery position (rolling patient onto left side). If the patient is not breathing proceed onto step 3.
3. Correct the lack of breathing by performing rescue breathing using mouth-to-mask or mouth-to-barrier device, if available. If not available, use mouth-to-mouth. Blow slowly into the patient's mouth, using only enough force to make the chest rise. Use slow, gentle, sustained breaths that make the chest rise. Each breath should be 1 to 1-1/2 seconds per breath instead of 1-1/2 to 2 seconds for an adult. Remove your mouth after each ventilation to allow the lungs to deflate. Breathe for the patient a second time. Give two slow breaths. If airway is obstructed, reposition head and try to ventilate again. Watch chest rise, allow for exhalation between breaths. After the first two breaths, rescue breathing for a child is done slightly faster than an adults at a rate of one breath every 3 seconds with about 20 breaths per minute (instead of one breath every 5 seconds with about 12 breaths per minute for an adult). Be careful not to overfill lungs (a child's lung capacity is less than that of an adults) and watch for gastric distension (air getting into the stomach instead of the lungs).
We encourage everyone with or without children to attend a class for Cardiopulmonary Resuscitation instruction and certification. The best class is one that is offered to "health care providers" since this one will have instruction for working with children and babies as well as working with adults. Nothing can replace actual hands-on experience with learning this life saving technique. A life you may save may be someone close to you. Classes can be found at local American Red Cross organizations and also are available at most local hospitals. Check your yellow pages and call these organizations for class instruction in your area. It is well worth the cost of the class.
For more information about Child CPR (ages 1 - 8 years), see CPR Child, One Rescuer
CARDIOPULMONARY RESUSCITATION LINKS
ADULT CPR, ONE PERSON RESCUER
ADULT CPR, TWO PERSON
CHILD CPR, ONE PERSON & Airway Obstruction (1 year to 8 years old)
INFANT CPR, ONE PERSON & Airway Obstruction (Less than 1 year old)
CPR COMPLICATIONS & LEGALITIES
INFANT RESCUE BREATHING STEPS
(Under 1 year of age)
Rescue breathing for infants: If the patient is an infant (a child under the age of 1 year), you must vary rescue breathing techniques slightly. Keep in mind that the infant is tiny and must be treated very gently. The steps in rescue breathing for an infant are as follows:
1. Establish unresponsiveness. This can be done by gently shaking the infant's shoulder or tapping on the bottom of the foot. If the infant is unresponsive, place the infant on his or her back and proceed to step 2. If second rescuer is available, have him or her activate EMS system.
2. Open airway (head-tilt-chin-lift or jaw thrust technique). Check breathing (look for the rising and falling of the infant's chest, listen for the sound of air moving in and out of the infant's mouth and nose, and feel for the movement of air on the side of your face and ear). Continue to look, listen, and feel for 3 to 5 seconds. If infant is breathing or resumes breathing, place in recovery position (infant rolled over onto left side). Do not tip the infant's head back too far because this may block the infant's airway. Tilt only enough to open airway. Check for any visible secretions or foreign objects. Use finger sweep only if there is a foreign object visible. If suction is needed, use it gently (can be done with a bulb syringe, also called an ear syringe). If infant is not breathing, proceed onto step 3.
3. Correct the lack of breathing by performing rescue breathing. Cover the infant's mouth and nose with your mouth. Blow gently into the infant's mouth and nose for 1 to 1-1/2 seconds per breath. Watch the chest rise with each breath. Remove your mouth and allow lungs to deflate. breathe for the infant a second time. If airway is obstructed, reposition head and try to ventilate again. Watch chest rise, allow for exhalation between breaths. Be careful not to overfill lungs (an infant's lung capacity is less than that of an adults... the right amount of air is about what an adult can hold in their mouths with their cheeks puffed out, not their lungs!). Watch for gastric distension (air getting into the stomach instead of the lungs). After these first two breaths, breathe into the infant's mouth and nose every 3 seconds (20 rescue breaths per minute).
Often when mouth to mouth rescue breathing is necessary, external cardiac compressions are also required. For more information about Infant CPR (ages 1 - 8 years), see CPR Infant, One Rescuer
CARDIOPULMONARY RESUSCITATION LINKS
ADULT CPR, ONE PERSON RESCUER
ADULT CPR, TWO PERSON
CHILD CPR, ONE PERSON & Airway Obstruction (1 year to 8 years old)
INFANT CPR, ONE PERSON & Airway Obstruction (Less than 1 year old)
CPR COMPLICATIONS & LEGALITIES
You may transport a child for emergency medical care if you can do it safely and quickly.
TRANSPORTING A CHILD WHO NEEDS EMERGENCY CARE
You may be able to transport a child for emergency care if:
- The child is awake and responding (response may be slow or confused).
- The child is breathing without problems.
- Two adults are present: one who can drive safely and one who can care for the child.
- The child does not have a head, neck, or back injury.
In some communities, it may always be best to call an ambulance for safe and quick transport because of traffic and distance to health care. EMTs can also provide oxygen and resuscitation assistance, if needed.
FEVER SEIZURES
Checking Your Symptoms: If you answer yes to any of the following questions, see a health care professional.
Review health risks that may increase the seriousness of your child's symptoms.
Note: All temperature guidelines listed in this topic are rectal. A child has a fever when his or her temperature is 100.4°F (38°C) or higher, measured rectally. For information about taking accurate temperatures in infants and children, see Fever. If your child has had a febrile seizure in the past and you have talked with your health care professional about how to care for your child after a seizure, be sure to follow his or her instructions.
- Does your child have a fever and any signs of a serious infection? Signs include:
- Severe headache, neck pain or stiffness, and fussiness.
- Being very sleepy or hard to wake up.
- Acting confused or struggling with you for no reason.
- A bulging soft spot (fontanel) on an infant's head when the baby is not crying.
- Does your child have a fever and any breathing problems? Breathing problems include:
- Mild difficulty breathing.
- Drooling and not wanting to swallow.
- Does your child have a fever and pain?
- Does your child have a rectal temperature of 105°F (40°56°C) or higher?
- Does your child have a fever and new swelling, severe pain, sudden redness, or warmth in or around a joint?
EVALUATING PAIN IN A YOUNG CHILD
When a young child is in pain, his or her parents usually know it. However, pain can be difficult for a young child to describe. An older child may be able to describe the pain as sharp or cramping or tell whether the pain comes and goes (intermittent). When a young child is in pain, the signs sometimes can be hard to recognize. Watch for changes in how your child acts.
The signs listed below may help you decide if your child's pain is mild, moderate, or severe. A child with severe pain will have more of these behaviors, the behaviors will be more constant, and you will be less able to comfort the child. Look for:
- Changes in usual behavior. Your child may eat less or become fussy or restless.
- Crying, grunting, or breath-holding.
- Crying that cannot be comforted.
- Facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance.
- Sleep changes, such as waking often or sleeping more or less than usual. Even children in severe pain may take short naps because they are so tired.
- Body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging to whoever holds him or her, or not moving.
- A child between the ages of 18 months and 3 years may complain of pain or tell you he or she is not feeling well.
If a visit to a health care professional is not needed immediately, see the Home Treatment section for self-care information.
- Does your child have a fever and a new skin problem? Skin problems include:
- New, tiny purple or red spots (petechiae).
- Recent onset of bruises (purpura) without having an injury.
- A skin infection (cellulitis).
- Is this your child's first seizure, and there are no signs of serious illness?
- Has your child had fever (febrile) seizures in the past and now has had another febrile seizure?
FEVER SEIZURES HOME TREATMENT
During a seizure:
- Protect the child from injury. Ease the child to the floor, or lay a very small child face down on your lap. Do not restrain the child.
- Turn the child onto his or her side, which will help clear the mouth of any vomit or saliva. This will help keep the tongue from blocking the air passage so the child can breathe. Keeping the head and chin forward (in the same position as when you sniff a flower) also will help keep the air passage open.
- Loosen clothing.
- Do not put anything in the child's mouth to prevent tongue-biting. This may injure the child.
- Try to stay calm, which will help calm the child. Comfort the child with quiet and calm talking.
- Time the length of the seizure and pay close attention to the child's behavior during the seizure so you can describe it to your health professional.
After a seizure:
- If the child is having difficulty breathing, turn his or her head to the side, and, using your finger, gently clear the mouth of any vomit or saliva to aid breathing.
- Check for injuries if the child was moving a lot and may have been hurt.
- For home treatment of a fever, see Fever.
- If the child does not need to see a health care professional right away, put him or her in a cool room to sleep. Sleepiness is common following a seizure. Check on the child often. Normal behavior and activity level should return within 60 minutes of the seizure.
- If your child has had a fever (febrile) seizure in the past and you have talked with your health care professional about how to care for your child after a seizure, be sure to follow your health professional's instructions.
Symptoms to Watch for During Home Treatment: If one or more of the following symptoms occur during home treatment:
- Your child has another seizure with the same fever illness.
- Your child develops other symptoms, such as a cough.
- Your child's symptoms become more severe or frequent.
FEVER SEIZURES: PREPARING FOR A MEDICAL VISIT
You may feel upset after seeing a febrile seizure. Stay calm. You can help your child's health care professional diagnose and treat your child's condition by being ready to answer the following questions:
- How was the child's health and behavior before the seizure?
- Had the child had an accident or suffered any trauma before the seizure?
- What happened during the seizure?
- What kind of body movements were there?
- How long did the seizure last?
- How did the child act immediately after the seizure?
- Have you noted any injuries from the seizure?
- Has the child ever had a seizure before?
- When did the fever start?
- How high is the fever?
- How often does your child get a fever, and how long does it usually last?
- Does your child have any health risks that may increase the seriousness of your child's symptoms?
- Has your child had other health problems over the past 3 months?
- Has your child been eating and playing normally?
- What home treatment measures, including non-prescription medications, have you used? Did they help?
- Ask your health care professional what you can do to prevent another seizure and what to do if another seizure occurs.
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