Seizures in Children

Introduction

All children who seize for the first time and many with a known seizure disorder should be evaluated by a doctor.

• Most children with first seizures should be evaluated in a hospital's emergency department. However, if the seizure lasted less than 2 minutes, if there were no repeated seizures, and if the child had no difficulty breathing, 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, contact your child's doctor for further advice. Your pediatrician may recommend either an office or an emergency department visit. If you do not have a pediatrician or none is available, bring the child to the emergency department. If you are worried about possible absence seizures, evaluation at the pediatrician's office is appropriate.
• Caregivers of children with epilepsy   should contact the child's pediatrician if there is something different about the type, duration, or frequency of the seizure. The doctor may direct you to the office or to the emergency department.
• Take the child to the emergency department or call 911 if you are concerned that your child was injured during the seizure or if you think that he or she may be in status epilepticus (seizures of any kind that do not stop).

Most children who have seized for the first time should be taken to the emergency department for an immediate evaluation.

• Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly injured should go to the hospital by ambulance.
• If the child has a history of seizures and there is something different about this one, such as duration of the seizure, part of body moving, a long period of sleepiness, or any other concerns, the child should be seen in the emergency department.

Self-Care at Home

Your initial efforts should be directed first at protecting the child from additionally injuring himself or herself.

• Help the child to lie down.
• Remove glasses or other harmful objects in the area.
• Do not try to put anything in the child's mouth. In doing so, you may injure the child or yourself.
• Immediately check if the child is breathing. Call 911 to obtain medical assistance if the child is not breathing.
• After the seizure ends, place the child on one side and stay with the child until he or she is fully awake. Observe the child for breathing. If he or she is not breathing within 1 minute after the seizure stops, then start mouth-to-mouth rescue breathing (CPR). Do not try to do rescue breathing for the child during a convulsive seizure, because you may injure the child or yourself.
• If the child has a fever  , acetaminophen (such as Tylenol) may be given rectally.
• Do not try to give food, liquid, or medications by mouth to a child who has just had a seizure.
• Children with known epilepsy   should also be prevented from further injury by moving away solid objects in the area of the child. If you have discussed use of rectal medication (for example, Valium) with your child's doctor, give the child the correct dose.

Prevention

Most seizures cannot be prevented. There are some exceptions, but these are very difficult to control, such as head trauma and infections during pregnancy  .

• Children who are known to have febrile seizures should have their fevers well controlled when sick.
• The biggest impact caretakers can have is to prevent further injury if a seizure does occur.
• The child can participate in most activities just as other children do. Parents and other caretakers must be aware of added safety measures, such as having an adult around if the child is swimming or participating in any other activities that could result in harm if a seizure occurs.
• One common area for added caution is in the bathroom. Showers are preferred because they reduce the risk of drowning more than baths.

Outlook

The prognosis for children with seizures depends on the type of seizures. Most children do well, are able to attend regular school, and have no limitations. The exceptions occur with children who have other developmental disorders such as cerebral palsy and in children with neonatal seizures and infantile spasms. It is important to talk with your child's doctor about what to expect with your child.

• Many children "outgrow" seizures as their brains mature. If several years pass without any seizures, doctors often stop the child's medications and see if the child has outgrown the seizures.
• A seizure in general is not harmful unless an injury occurs or status epilepticus develops. Children who develop status epilepticus have a 3-5% risk of dying from the prolonged seizure.
• Children with febrile seizures "outgrow" them, but they often have repeated seizures when they develop fevers while they are young. Some children with febrile seizures go on to have epilepsy, but most doctors believe the epilepsy was not caused by the febrile seizures.