Seizures & fever

When to Seek Medical Care

With any medical concern, if you determine immediate medical emergency is not necessary, you may call your doctor for instructions on how to handle a febrile seizure. Your doctor may advise you to come to the office or to proceed directly to a hospital’s emergency department.

Understandably, unprepared parents and other caregivers who have never dealt with a seizure before will likely be compelled to call 911 when their child is having a seizure. In most cases, the seizure will have stopped by the time emergency medical personnel arrive. Even so, it is wise to have the child seen promptly either by the regular physician or in the hospital’s emergency department.

• It is important to consider and exclude other causes of seizures. Although serious infections such as meningitis   are infrequent, these should be ruled out with a careful medical evaluation.
• If a child should have another febrile seizure, the parents should understand that it is not necessary to automatically call 911. The home care measures should be followed.
• Even after a brief repeated febrile seizure, it is wise to take the child to the physician’s office or hospital emergency department for an examination.
• Call 911 for emergency medical transport in these cases:
  1. The seizure lasts more than 5 minutes.
  2. The child has serious trouble breathing or stops breathing.
  3. The child develops cyanosis (blueness of the skin) indicating insufficient oxygen in the bloodstream.

Self-Care at Home

These aspects of home care need to be considered:

• Care of the child during the seizure: During a seizure, only a limited amount of intervention should be undertaken. The main objective is to protect the child’s airway so that breathing is maintained. Protection from other injury is important.
  1. Remove objects, such as food and pacifiers, from the mouth.
  2. Place the child on his or her side or abdomen.
  3. Clear the mouth with a suction bulb (if available) if there is vomiting.
  4. Perform a jaw thrust or chin lift maneuver if there is noisy or labored breathing.
  5. Do not try to restrain the child or try to stop seizure movements.
  6. Do not force anything into the child's mouth. Don't try to hold the tongue. (It is not necessary to try to prevent the tongue from being swallowed.)
• Control of the fever  : Because the seizure is being caused by fever, measures should be taken to lower the body temperature.
1. Remove clothing.
2. Apply cool washcloths to the face and neck.
3. Sponge the rest of the body with cool water (do not immerse a seizing child in the bathtub).
4. Give medication to lower the fever (acetaminophen suppositories in the rectum, if available). Oral medications should not be given until the child is awake.
• Consider the cause of the fever: This is probably best left up to the doctor's medical evaluation.

Follow-up

The child’s doctor should provide guidance as to when a follow-up visit is indicated. In the case of simple febrile seizure, the need for a short-term follow-up visit would depend on the nature of the illness causing the fever. The child’s physician can use the follow-up visit as an opportunity to discuss febrile seizures with the parents.

• Although fever control is important, it is unclear how effective this is at preventing another episode of febrile seizures. Still, it seems reasonable to try to take these measures to control fever during an illness. Give acetaminophen (Tylenol, Tempra, and other children's formulas as directed by your doctor or on the label) or ibuprofen (Motrin, Advil, and others).
• Alternating doses of acetaminophen and ibuprofen such that medication is given every 3-4 hours is common, although some authorities are concerned that this practice is of unproven safety and benefit.
• Sponge bathing with lukewarm water must be done for 15-20 minutes. The water must not be so cool that the child shivers (shivering tends to keep body temperature up). The lowering effect of sponge bathing on body temperature will not last unless the child has also been given acetaminophen or ibuprofen.