Brief overview
- Symptoms: Fever, muscle twitching, twisted eyes, sudden unconsciousness, pale skin, blue lips.
- Course: Mostly uncomplicated and unproblematic course, permanent damage is very rare
- Treatment: The symptoms usually disappear by themselves. The doctor treats a febrile convulsion with anticonvulsant medication, among other things. In addition, antipyretics and cold compresses are suitable.
- Description: Seizure that occurs in association with fever (body temperature above 38.5 degrees Celsius).
- Causes: As yet unclear; a genetic predisposition is suspected in conjunction with mostly harmless infections (e.g., of the upper respiratory tract) that lead to a rapidly rising body temperature
- Prevention: Prevention is usually not possible; in case of recurring attacks, have antispasmodic medication prescribed by a doctor at home.
- When to see a doctor? A visit to the doctor is recommended after every febrile seizure.
How do you recognize a febrile convulsion?
In a febrile seizure, children twitch all over their body, their muscles cramp and their body is unnaturally stiff and stretched. Usually the whole body is affected, but in some cases only individual limbs (e.g., arms and legs) are affected. Sometimes the arms and legs suddenly go limp again. Usually, the child twists the eyes upward, has dilated pupils or a fixed gaze.
Some children are pale, and their skin sometimes turns blue briefly – especially on the face and around the lips. Breathing is often slowed and labored. During the course of the convulsion, the child also often loses consciousness.
Typical symptoms of a febrile convulsion are:
- Fever (body temperature above 38.5 degrees Celsius).
- Muscle twitching
- Twisted eyes
- Sudden loss of consciousness
- Pale or blue colored skin
Depending on what symptoms are present in a febrile convulsion, a distinction is made between simple and complicated febrile convulsions:
A simple or uncomplicated febrile convulsion lasts only three to four minutes, or a maximum of fifteen minutes. It affects the whole body and is usually harmless. Usually, there is no further seizure in the first 24 hours after the first one.
Complex (complicated) febrile seizure.
A complex or complicated febrile seizure lasts longer than 15 minutes and may recur within 24 hours. A complicated febrile seizure is the first sign of subsequent epilepsy or other illness in about four out of 100 cases, and should be evaluated by a doctor. This type of febrile convulsion occurs much less frequently.
What is the course of a febrile seizure?
As threatening as a febrile convulsion looks, the child usually recovers from it very quickly. A simple febrile convulsion lasts only a few seconds to minutes (maximum 15 minutes). The symptoms usually disappear again on their own.
Is a febrile convulsion dangerous?
As a rule, febrile convulsions are not dangerous, and certainly not fatal. It is true that parents are usually very frightened when a febrile convulsion occurs – especially if it is the first one. They fear for the child’s life, because a febrile convulsion often looks very dramatic. However, the vast majority of convulsions are uncomplicated and unproblematic. The prognosis is usually very good.
Children with febrile convulsions develop just as well as children without febrile convulsions. The convulsions do not damage the child’s brain. However, with simple febrile convulsions, about one in three children is at risk for recurrence. Once children reach school age, the seizures usually stop.
In any case, consult a doctor after a febrile convulsion to rule out serious illnesses (e.g., meningitis).
What complications can occur?
Consequential damage to the child’s mental or physical development is not to be expected in most cases: Children develop just as normally as children without febrile convulsions.
In most cases, febrile convulsions are over by the time the parents arrive at the hospital or doctor’s office with their child. To be on the safe side, doctors then perform some tests and rule out other causes and complications.
Febrile convulsions and risk of epilepsy
In rare cases, epilepsy is behind the repeated seizures. The risk of developing epilepsy is increased in children especially if:
- the seizures occur before the age of nine months and there is a family history of epilepsy.
- @ the convulsions last longer than 15 minutes.
- the child is not developing mentally or physically according to his or her age even before the seizure.
Without these risk factors, only about one percent will develop epilepsy after febrile convulsions.
Especially when a febrile seizure occurs for the first time, the most important thing is to remain calm and prevent the child from hurting himself by uncontrolled movements. To do this, observe the following measures:
- Stay with the child, and remain calm.
- Check the child’s consciousness and breathing
- Dial 911 as soon as possible (in Germany call 112), or inform a pediatrician (especially if it is the first febrile seizure).
- Loosen the child’s clothing so that he or she can breathe freely.
- Move hard objects out of the way (e.g., edges, sharp corners) so the child does not hurt himself.
- Do not hold or shake the child.
- Do not try to suppress or prevent the child’s twitching.
- Do not give the child food or drink (risk of choking!).
- Do not put any objects in the child’s mouth, even if the child bites its tongue.
- Look at the clock to see how long the seizure lasts.
- Once the seizure is over, place the child in the recovery position.
- Then take the child’s body temperature.
If the child is unconscious and not breathing, start resuscitation efforts immediately and call 911!
After the seizure, it is important that a doctor examines the child. Only in this way is it possible to rule out other, more serious illnesses (e.g. meningitis) with certainty. In addition, doctors recommend that a child be hospitalized until about one and a half years of age after the first febrile seizure.
Possible reasons for hospital admission include:
This is the child’s first febrile seizure.
- It is a complicated febrile seizure.
- The cause of the seizure is unclear (e.g., suspected epilepsy).
If the child has already had febrile convulsions several times and the seizures last longer than a few minutes, the doctor may prescribe an emergency medication for the parents to take at home. This is usually an anticonvulsant medication that is administered through the child’s anus like a suppository. Your pediatrician will tell you exactly how to use this and how to store the medicine.
What is a febrile seizure?
A febrile convulsion is a seizure caused by a rapid rise in body temperature (usually above 38.5 degrees Celsius). Febrile convulsions are more common, especially in young children. Most of the time, a febrile seizure in children seems frightening, but it is usually harmless.
Who is particularly affected?
Hereditary factors also play a role: If febrile seizures have already occurred in the family, the probability that the child will have seizures increases.
At a later age (even in adults), febrile seizures are rare but possible. However, it is not yet clear why this occurs.
What triggers a febrile seizure?
It is not known exactly why some children are prone to convulsions when they have a fever. According to current knowledge, the brain of people with febrile convulsions is predisposed to react to fever or a rapid rise in body temperature (usually above 38.5 degrees Celsius) with seizures at a certain stage of development. Doctors believe that the brains of children between the ages of eight months and four years are particularly susceptible to seizures.
In babies, febrile convulsions also occur at temperatures as low as 38 degrees Celsius.
Febrile convulsions frequently occur in the context of three-day fever (infection with human herpesvirus type 6, HHV 6). Less commonly, bacterial infections (e.g., streptococcal angina or urinary tract infection) are responsible for a febrile convulsion.
Whether a febrile convulsion occurs depends primarily on how quickly the body temperature rises.
Only very rarely is febrile seizure caused by serious infections such as meningitis or pneumonia. Febrile convulsions can also be observed after vaccinations (e.g. against whooping cough, measles, mumps, rubella, polio, diphtheria or tetanus).
Whether the fever itself or the fever-inducing infection causes the seizure is not yet fully understood. Doctors assume that a predisposition to febrile convulsions is congenital and therefore occurs in some families in several members.
How can febrile convulsions be prevented?
It is not possible to prevent febrile convulsions entirely. Some parents give their children fever-reducing medication as soon as the body temperature reaches 38.5 degrees Celsius. They hope that this will protect the child from a febrile convulsion. However, there is no scientific evidence that this prevents a febrile convulsion. Doctors therefore advise against giving fever-reducing drugs as a preventive measure!
Use fever-reducing drugs only after consulting your pediatrician. An “overtherapy” with fever-reducing preparations must be avoided at all costs!
If the child has already suffered a febrile convulsion, doctors sometimes prescribe emergency medications (e.g., anticonvulsants) for parents to take home. However, administer these only if the child actually has a fever and only as prescribed by the doctor. Giving the remedies as a preventive measure in case of an infection is not recommended!
Febrile convulsions can be prevented in very few cases.
After the first febrile convulsion, a child should always be thoroughly examined by a physician. Exceptions exist if children have already had several febrile convulsions that were easily manageable and passed quickly. However, since other causes are possible with each new convulsion, it is advisable to always seek medical advice.
In the case of a complicated febrile convulsion, it is essential that the child be thoroughly examined in the hospital. As a rule, children with a complicated febrile seizure stay in the hospital for at least one night in order to clarify the exact cause and to observe the course.
How does the doctor make the diagnosis?
The doctor first asks the accompanying persons (usually the parents) what symptoms occurred, how long the seizure lasted and which parts of the body were affected and in what order. Since a febrile seizure is manifested by typical symptoms (fever plus seizure), it is usually easy for the doctor to diagnose.
Only if serious illnesses are suspected, such as meningitis, will the doctor perform further examinations to clarify the cause. These include, for example, blood tests or an examination of the cerebrospinal fluid (lumbar puncture) to rule out infections.
Epilepsy or other neurological disorders can be diagnosed by measuring the brain wave (electroencephalography, EEG). Imaging examination procedures such as a computer tomography (CT) or magnetic resonance imaging (MRI) make the structures of the brain visible in order to exclude malformations or tumors as the cause of complicated febrile convulsions.
