Febrile Seizures

This scenario plays out hundreds of times, every day in the Greater Toronto Area. Your child has suffered from a febrile seizure.



I have seen it hundreds of times. It is always the same. It goes something like this...

Your healthy child is sick with a cold and fever and stays home from daycare or school with you, your partner or sometimes even your parents or in laws. Suddenly without warning, your child looses consciousness, becomes rigid, turns blue and then has a seizure. Panicked, you call 9-1-1 for help. You are scared and think, no you believe, your child is dying.  

I get the call...

Medic 868 respond on a delta for a 3-year-old in seizure, no history. Has been sick with a cold and fever.

A delta call is one of the highest priority calls paramedics respond to and implies a potential or perceived imminent threat to life or limb. The police and fire department will also respond, just in case. Off we go to your house with our lights flashing and our siren blaring. In our minds we go through and prepare an action plan. We do medical math to determine drug dosages should we have to administer medication to stop your child’s seizure. We prepare a game plan of how we will manage the scene and care for your child. And then we get an update from dispatch...

Medic 868 downgrade to an alpha response. Seizure has stopped and the patient is conscious and crying.”

Relieved, we turn off the lights and sirens and proceed to your house. When we arrive, we assess your child, calm you down, help you prepare for the trip to the hospital and then transport you and your child to the local emergency department for follow up care and reassurance. Later, you return home relieved to know that this was a completely normal event and that your child is fine.

This scenario plays out hundreds of times, every day in the Greater Toronto Area. Your child has suffered from a febrile seizure. It is rarely epilepsy and it is generally not life threatening with no lasting effects.1 Just as the name implies, a febrile seizure is defined as a seizure occurring in children over the age of one month, as a result of a fever and with no prior history of any neurological problems.12 Affecting 3% - 8% of children, it is the most common type of seizure and occurs between the ages of 6 months and 5 years with a peak age of 18 – 22 months.234

Causes and Prevention of Febrile Seizure

A febrile seizure occurs as a direct result of a fever.1 It has nothing to do with how high or fast a fever comes on although children with a predisposition to febrile seizures tend to have higher fevers.2 It is simply the presence of a fever which can even come on after the seizure has stopped. A fever is when the core temperature, the inside body temperature, rises above 38°C (100.4°F).1234 We know very little about the science behind febrile seizures but the science has demonstrated that genetics plays an important role and that there is an increase in likelihood that a child will develop febrile seizures if one or both of their parents also suffered from febrile seizures when they were children.4

There is nothing that we can do to prevent a febrile seizure. Giving Tylenol or Advil will treat the fever but will not prevent a child from having a febrile seizure.2 Likewise cooling your child in a cool bath or with wet towels will not prevent a seizure.24 All we can do is remember that a febrile seizure is benign. It is scary but nothing to worry about. It causes no long term effect. It is a normal event for a small percentage of children who have a febrile seizure and they will outgrow it.124

Treatment
There is no treatment or investigations required for a febrile seizure.234  I am not saying that you should not call and ambulance or go to the hospital. I am saying that if the seizure is truly a febrile seizure then your child will be fine. The doctor at the hospital will reassure you but they will not generally do blood work, CT scans or any other investigations. The exception to this is if the child has a febrile seizure lasting more than 15 minutes or they cannot determine the cause of the fever.  In these very rare cases more medical investigations will be ordered by the doctor.

So, if your child has a febrile seizure take a deep breath and be reassured that they, in overwhelming likelihood, will be absolutely fine. Call 9-1-1 immediately. Make sure that the lights are on so that we can locate your house number. Unlock the front door so that we can get in. Record the time that the seizure starts and stops. Keep your child safe and do not put anything in their mouth or hold their arms or legs down. Protect their head and let the seizure happen. Get a bag ready to go with you to the hospital including toys, diapers, wipes, drinks, and snacks. Don’t forget your child’s health card and medicines.

Of equal importance is the need for you and your family to prepare for emergencies. Take a first aid and/or CPR course. Practice these life saving skills. Know your emergency number and educate your family on how to get help.

References
1. CHEO. (n.d.). Febrile Seizure. Retrieved 01 12, 2016, from CHEO:  http://www.cheo.on.ca/en/febrile-seizure
2. Patel, N., Ram, D., Swiderska, N., Mewasingh, L. D., Newton , R. W., & Offringa, M. (2015, 08 18). Febrile seizures. British Medical Journal, 351 (Online).
3. Khair, A. M., & Elmagrabi, D. (2015). Febrile seizures and febrile seizure syndromes: An updated overview of old and current knowledge. Neurology Research International, 2015.
4. Shellhaas , R., & Engel Jr, J. (2014, 01 24). Febrile seizures. Neurology Medlink.

About the Author
Robbie Ichelson is the Chief Learning Officer and Director of canaPHEM which provides authentic prehospital education including first aid and CPR to families, workplaces, and organizations throughout the GTA. He practiced paramedicine as an advanced care paramedic for over 20 years in urban, suburban and rural Ontario.  During his time as a paramedic, he has educated and mentored many paramedics through all phases of their initial and ongoing education. Robbie is also a researcher focusing on prehospital sepsis identification and management by paramedics. He lives in Whitby with his wife and four children ranging in age from 4 – 16. You can contact Robbie at info@canaphem.ca or by visiting his companies website: www.canaphem.ca.

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