FEBRILE SEIZURES| 10 TIPS ON HOW TO PREVENT AND WHAT TO BEWARE OF

Febrile seizures are frightening, particularly for new parents or those witnessing it for the first time. Nigeria alone records more than one hundred thousand cases per year. Being a nurse, handling such cases is a recurring decimal. It is common to see agitated parents hurriedly bring children between the ages of 3 months – 3 years to the hospital. It’s sad though, when a child dies from complications associated with a convulsion.

Like many others, his condition had deteriorated before he arrived.

In the process of history taking, I noticed and inquired as to why his body appeared to have been immersed in oil and what the strong overpowering smell was.

febrile seizures

Bad Practices

The mother, in shock and short of words, barely had an answer for me. Just then, someone, probably a neighbor, mumbled from behind, that he was given a mixture of kernel and olive oil to drink, and probably a splash of water. 

This, they explained, was in an attempt to abort the seizure.

Apparently, the poor boy was clamped during the episode – clenched jaw and twitching. His gums were visibly injured. They had used a spoon to keep his mouth open in order to stop him from biting down on the tongue as well as allow easy passage of their mixture. Unfortunately, the concocted mixture went the wrong way and was aspirated to his suffocating lungs. This further dampened interventions for resuscitation.

Upon further examination, he had high grade fever 39oC (102.2°F), semiconscious state (GCS -9), low oxygen in the blood – concentration lower than 60%, crepitation in the chest as well as laboured breathing.

Finally stable but with unavoidable complications such as aspiration pneumonia – a type of lung infection arising from aspiration of material from the stomach or mouth into the lungs. Oxygen was administered alongside medications for the fever and spasm. It was saddening to watch him fight for his life.

Sometimes, in an attempt to abort a seizure, people do more harm than good. In 2019, a  Facebook post circulated claims that a mixture of onion, ginger, garlic and oil can halt convulsions in children. This is entirely misleading and false.

There are lots of wrong practice, hence, knowing the right intervention to take during an episode of febrile convulsion is important.

What’s febrile seizure (febrile convulsion)?

A febrile seizure is a convulsion in a child caused by a spike in body temperature, often from an infection -1-

Sara Raftery -2- an Irish paediatric nurse added that febrile convulsion can occur without central nervous system infection.

Often times, a febrile seizure is associated with epilepsy or other neurological symptoms. This isn’t true as it is a normal occurrence in young children with or without any neurologic symptoms.

Typically, a seizure happens when your child’s muscles contract violently, mostly because a great number of the cells in the brain send out erratic electrical charge simultaneously.

Convulsion most commonly occurs on the first day of a fever. Most times, it lasts for only a few minutes and is usually harmless. Common features include staring, severe shaking or tightening of the muscles and sometimes, loss of consciousness. It is important for children to be medically evaluated during their first seizure.  Once it becomes recurrent and especially if each episode endures more than 10 minutes, emergency medical care is required.

 

Complex febrile seizures result when fever lasts longer than 15 minutes. So, when a child’s spasms reappear more than once within 24 hours, or are limited to one side of the child’s body, then it’s beyond the regular harmless seizure.

What are the symptoms of febrile seizures?

Febrile convulsion can be categorized into simple and complex seizures:

Simple convulsion

  • The symptoms of febrile seizures aren’t very hard to spot.
  • Fever higher than 100.4 F (38.0 °C)
  • The characteristic loss of consciousness.
  • Twitching limbs.
  • Convulsions (often in a regular pattern).

Others are

  • confusion
  • Exhaustion after the jerky movements.

Features of simple convulsion

  • Simple febrile seizures are the commonest.
  • It’s harmless; typically last less than 2 minutes, though the twitching can last up to 15 minutes.

These sorts of febrile seizures merely happen once in a 24-hour period.

– Complex Convulsion –

  • In complex febrile seizures, twitching lingers beyond 15 minutes. Several seizures could occur over a 30-minute duration. As a distinguishing feature, it may happen more than once during a 24-hour period.

Some symptoms aren’t specific, such as:

  • loss of consciousness
  • twitching limbs
  • convulsions

Specific symptom include

  • temporary weakness usually in one arm or leg

Recurrent Febrile Seizure

Sometimes, simple or complex febrile seizure occurs repeatedly. This is known as a recurrent febrile seizure and the signs include:

  • Body temperature for the first attack could be lowered.
  • Subsequent seizure often happens within a year of the first seizure.
  • Fever may not be as high as the initial febrile seizure.
  • The child must be having fevers more frequently.

It’s possible for seizures to occur over and over with increasing risk if :

  • Your close family member has a history of recurrent febrile seizures.
  • The time-lapse between the onset of the fever and the seizure was short.
  • The first seizure occurred when your child was 18 months.
  • The child’s first seizure ensued from a low fever.

As much as this can be distressing, it is very important not to panic. Calm and coordination is a sure way to avoid irrational behaviors in such moment.

Causes of Febrile Seizures

Fever indicates illness but febrile seizures can occur before you realize your child is sick or notice any signs and symptoms. Febrile seizures can happen following:

  • Immunization – certain vaccines can stimulate a high grade fever after immunizations especially for MMR (mumps measles rubella) and PENTA (diphtheria, pertussis (whooping cough), tetanus, hepatitis B, and Haemophilus influenzae type B (Hib)). Most often, this fever occurs 8 to 14 days after immunization.
  • Virus or a bacterial infection – viral infection such as Roseola is usually marked by several days of high fever, followed by a distinctive rash just as the fever breaks and can result in febrile seizures. 
  • Other risk factors includes – having family members who have had febrile seizures.

Dos and Don’ts - Treatment for febrile seizure

Without complications, febrile seizures leave no lasting problems. It remains advisable to always contact your child’s paediatrician, or medical professional immediately your child has a seizure. This will allow the doctor probe for other causes such as meningitis.

Dos

  • Place your child on a warm surface.
  • Roll your child onto their side.
  • Remove or move things that might injure them during the convulsions (furniture, sharp items, utensils etc.)
  • Loosen tight clothing surrounding the head or neck.
  • Observe the time each seizure lasted.
  • Remove extra clothing if possible.
  • If your child vomits or drools, move your child onto his side and clear out his mouth.

Don’ts

  • Do not place anything in their mouth.
  • Do not try to restrict the movement during the convulsions or twitching.
  • Do not rub oily substances on your child’s body.

How to prevent a febrile seizure?

Febrile seizures usually occur at the beginning of a fever and without warning. This makes febrile seizure difficult to prevent, except in some cases of recurring seizures.

However, there are over-the-counter medications for fever such as Ibuprofen or Acetaminophen that can be administered during a fever. Seizures due to fever have no lasting effects and except your child is on medications for recurrent febrile seizures, it’s not advisable to give any anti-seizure medicines to prevent future seizures.

 

Prescription anticonvulsant medications are rarely used by pediatricians to prevent/abort febrile seizures. These medications may have serious or adverse side effects that may overshadow any possible benefit.

Rectal diazepam (Diastat) or nasal midazolam might be recommended to be used as needed for children who are prone to long febrile seizures. In a clinic setting, these medications are used to treat seizures that persist  longer than five minutes or if the child has more than one seizure within 24 hours. These are however not prescribed to prevent febrile seizures.

When to see a doctor

As noted earlier, febrile seizures aren’t usually a cause for worry. Still, you should take your child to see a doctor or medical professional as soon as possible. Your physician would confirm or rule out anything else that may need further treatment.

Here are a few reasons to contact a medical professional immediately

  • Difficulty breathing
  • A stiff neck
  • Severe sleepiness
  • Vomiting

Factors that increase the risk of having a febrile seizure include:

  • Family history – researchers have found that certain genes are responsible for or increase susceptibility to febrile sei
  • Age of child –as noted earlier, most febrile seizures occur in children between 6 months and 5 years of age, with increasing risk between 12 and 18 months of age.

Complications associated with febrile seizures

Simple febrile seizures do not result in brain damage, intellectual disability or learning disabilities, and certainly do not mean your child has an extra serious underlying disorder.

Febrile seizures are activated by fever and surely don’t indicate epilepsy. Epilepsy on the other is caused by abnormal electrical signals in the brain.

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