Understanding Epilepsy in Children

When children experience their first seizure, or if they have a known seizure disorder, it's important to have them evaluated by a doctor.

• Most children who have their first seizure should receive an evaluation in a hospital's emergency department. However, if the seizure lasted less than 2 minutes, there were no repeated seizures, and the child had no breathing difficulties, it may be possible to have the child evaluated at the pediatrician's office.
• After the seizure has stopped, and the child has returned to normal, it's essential to contact your child's doctor for further guidance. Your pediatrician may recommend an office visit or a visit to the emergency department. If you do not have a pediatrician or none is available, bring the child to the emergency department. If there are concerns about possible absence seizures, an evaluation at the pediatrician's office is appropriate.
• Caregivers of children with epilepsy should reach out to the child's pediatrician if there is anything unusual about the type, duration, or frequency of the seizures. The doctor may guide you to either visit the office or go to the emergency department.
• If there are concerns that the child was injured during the seizure, or if it is suspected that the child may be in status epilepticus (a continuous seizure that does not stop), take the child to the emergency department or call 911.

Most children who experience their first seizure should be taken to the emergency department for immediate evaluation.

• Any child with repeated or prolonged seizures, breathing difficulties, or significant injuries should be transported to the hospital by ambulance.
• If the child has a history of seizures and there is something different about this episode, such as the duration of the seizures, specific body movements, extended drowsiness, or any other concerns, it's important for the child to be seen in the emergency department.

First Aid at Home

Your initial actions should prioritize protecting the child from further harm.

• Assist the child in lying down.
• Remove any eyeglasses or potentially harmful objects from the vicinity.
• Do not attempt to place anything in the child's mouth, as this can lead to injury for the child and yourself.
• Immediately check if the child is breathing. If the child is not breathing, call 911 for medical assistance.

After the seizure ends, position the child on one side and stay with them until they are fully alert. Monitor the child's breathing. If the child does not resume breathing within 1 minute after the seizure stops, begin mouth-to-mouth rescue breathing (CPR). It's important not to attempt rescue breathing during a convulsive seizure, as it may cause harm to the child or yourself.

If the child has a fever, acetaminophen (such as Tylenol) may be administered rectally.
Do not attempt to administer food, liquids, or medications orally to a child who has just experienced a seizure.
Children with known epilepsy should also be protected from potential injuries by removing solid objects from their vicinity. If you have discussed the use of rectal medication (e.g., Valium) with your child's doctor, administer the correct dose to the child.

Preventing Epileptic Seizures

In most cases, it's challenging to prevent seizures, with some exceptions, such as head trauma and infections during pregnancy.

• Children known to have febrile seizures should have their fevers well managed when they are ill.
• The primary focus for caregivers is to prevent further harm if a seizure does occur.
• The child can participate in most activities like any other child. However, parents and caregivers should be mindful of safety measures, such as having an adult present if the child is swimming or engaged in activities that might pose a risk in case of a seizure.
• Extra caution is typically needed in the bathroom, with showers being preferred over baths to reduce the risk of drowning.

Prognosis

The outlook for children with seizures depends on the type of seizures. Most children respond well, can attend regular school, and have no limitations. Exceptions include children with other developmental disorders like cerebral palsy, neonatal seizures, and infantile spasms. Discuss your child's prognosis with their doctor to understand what to expect.

Many children "outgrow" seizures as their brains mature. If several years pass without any seizures, doctors often discontinue the child's medications to see if the child has indeed outgrown the seizures.

In general, seizures are not harmful unless an injury occurs or status epilepticus develops. Children who experience status epilepticus have a 3-5% risk of fatality due to the prolonged seizures.

Children with febrile seizures typically "outgrow" them, but they may experience recurrent seizures when they develop fevers in their early years. While some children with febrile seizures go on to develop epilepsy, most doctors believe that the epilepsy was not directly caused by the febrile seizures.