This week’s guest columnist is Dr. Devan Szczepanski, a family practice resident at the University Hospital and Clinics here in Lafayette.
Mrs. Breaux gets a phone call at work from Sue’s daycare. Sue needs to be picked up because she has a fever. When Mrs. Breaux arrives, the teacher explains that 15 minutes earlier Sue fell to the floor and began shaking all over. The shaking lasted about one minute, then Sue relaxed and slept for about 10 minutes. Now she is waking up and when Sue sees her mom she runs over with bright red cheeks and gives mom a hug. The teacher is concerned and insists Mrs. Breaux bring Sue to the Emergency Room. However, Sue’s mom has seen this before and knows there is no need for panic. Marco, Sue’s older brother, also had febrile seizures.
Febrile seizures are much more common than people think! Up to 4% of children will experience the “hot shakes” before 5 years old. They sure make parents scared. Many parents are worried enough about fevers alone. Imagine adding some seizure activity to the mix! But the good news is that febrile seizures are perfectly safe and do not need a 9-1-1 call if the parent understands what to watch for.
By “febrile seizure” we mean, simply, a seizure that goes along with a fever. The child will have a temperature of 100.4 or greater, pass out, have rhythmic jerking of arms, face, or legs for a few minutes, and then be confused and sleepy afterward. The sleepy period, which we call the “post-ictal state,” lasts about 10 to 20 minutes and is followed by full awakening. Often the seizure happens first and then later the fever is noticed. Febrile seizures follow the rule of “S“: occur between Six months to Six years of age, are Short in duration, occur Soon after illness begins, and are more common among Siblings.
There is a lot of good news about febrile seizures. Seizures don’t hurt babies’ brains. Kiddos grow out of them. Only very few go on to have epilepsy (life-long seizures). Higher fevers do not increase a child’s chance of having a seizure. Just because a child has a temperature of 104 doesn’t mean he is going to seize. Some seize at 100.5, some 105, and the vast majority of kids with fevers of any height don’t have seizures. Most kids who have a febrile seizure never have another.
So what to do if my child has a seizure? The safest thing is to “hurry up and wait!” Meaning, don’t try to stop the jerking by restraining the child, don’t start CPR, don’t force things into the mouth. Your only job is to make sure the child can’t hurt themselves by bumping into furniture or slipping under water in the tub (another reason to never leave your child alone in a tub!). Please keep track of the length of time the seizure lasts. This is important because the decision for further tests or treatment is often based on how long the seizure lasted.
When to worry? If the seizure lasts longer than 5 minutes, call an ambulance. Paramedics carry medicine that can stop a seizure that lasts too long. If the child does not wake up soon enough after a seizure (again, about 10 to 20 minutes), this may mean the child is more sick than from a regular virus. Get her seen.
So if the fever is not frying my baby’s brain, then why is she having a seizure? GREAT QUESTION! All the “wise ones” of science have tried time and again to answer this question. Ultimately, it appears that it is mostly genetic. Your child has inherited a brain that is wired to occasionally seize when she has a fever. And then she outgrows that.
While it is important that your child see a doctor soon after the episode to be sure everything is okay, the main thing to remember is that while febrile seizures can be scary to watch, the seizure does not cause lasting harm. In the words of Dr. Hamilton, the fever will not “fry your baby’s brain.” Only YOUR nerves!