Our brain has continuous electrical activity. However, sometimes, the nerve sends out sudden, uncontrolled electrical signals, which cause changes in feelings, behavior or movement, referred to as a seizure. Seizures occur in approximately 4%–5% of all children. Approximately 1% of children are diagnosed with epilepsy (a tendency to have repeated seizures), with 1 in 26 children who have seizures eventually diagnosed with epilepsy. These data suggest that parents must be aware of what to do if a child has a seizure.
Seizures (fits) can be a challenging problem for primary care physicians when the cause is unidentified. Some parents associate seizures with dramatic symptoms; however, the symptoms can range from blank staring to convulsions, depending on the type of seizure and the part of the brain involved. Seizures can be frightening for many parents when they witness them for the first time, and they may fear initially that their child is dying. Thus, it is necessary for parents to accurately recognize a seizure, understand why it occurs, what to do and not do when their child experiences a seizure and when to seek emergency help.
Causes of seizures
Many times, the cause of the seizure cannot be determined, which can challenge doctors and frustrate the families of the children suffering from seizures. However, anti-seizure medications can help control the seizures. Some of the possible causes of seizures are mentioned below.
- Head injury
- Fever or infection
- Brain tumour
- Metabolic/electrolyte imbalance (low blood sugar, low calcium, or low/high sodium)
- Meningitis/encephalitis (Brain fever)
- Birth asphyxia (due to brain injury at birth)
- Epilepsy disorder
- Stroke
- Genetic factors
- Medications
Also Read: What happens if one stops epilepsy medication?
General symptoms of a seizure
- Brief jerky movements of arms & legs
- Blank stares and unresponsiveness (Absence seizure is common in neonates)
- Stiffening of the body and clenching of teeth
- Periods of rapid eye blinking
- Nodding head rhythmically or sudden head drop
- Repeated twitching of the face
- Falling suddenly with loss of awareness/consciousness
- Loss of bowel & bladder control
- Drooling of saliva or frothing from the mouth
Children may feel drowsy or disoriented after the episode. Always consult a physician when your child experiences these symptoms to confirm the diagnosis.
Although there are several types of seizures, in this article, we will discuss the most common type, febrile seizures.
Febrile seizures
It’s a type of seizure seen in children aged 6 months to 6 years, accompanied by fever and usually occurs within 24 hours of fever onset. Your Paediatrician will rule out other causes like brain infection/injury, metabolic/electrolyte disorder, epilepsy, before terming it as a febrile seizure. Febrile seizures cause stiffening and shaking of the body that lasts for a few minutes. Although it may be frightening to see it, it is harmless, and children outgrow these seizures. Febrile seizures can be simple and complex.
Simple Febrile Seizures
- Seen between the age group of 6 months to 6 years (peak age 12-18 months)
- Usually, each episode lasts from a few seconds to less than 15 minutes
- 1 episode in 24hrs (doesn’t recur within 24 hrs of 1st episode)
- Involves all 4 limbs. (Never focal [involving single limb or single side])
Complex febrile seizures:
- Each episode lasts for longer than 15 minutes
- More than one episode occurs within 24 hours
- Usually involves one side of the body
Also Read: Epilepsy in Kids: Problems Beyond Seizures
What should parents do during a seizure?
- Seizures can be scary to watch. As a parent, you should not panic but stay calm. Your main role is to protect your child. If more than one family member is present at home, one of them can video record the event or note the time the seizure started and ended. This is important for medical evaluation.
- Assess the situation and move objects that may cause injury to protect your child from getting injured.
- Turn the child to one side (preferably the left side) and keep a watch on their breathing.
- Clothes around the neck must be loosened to prevent airway obstruction; place something soft under the head.
- Do not feed anything or any medicines through the mouth as the child may aspirate.
- Do not attempt to place any metallic objects in the child’s hands.
- Do not stop your child’s movements; it will make them uncomfortable.
Febrile convulsions usually settle by themselves. If not self-controlled within 3–5 minutes, you can administer the anti-seizure medicine prescribed by the paediatrician. Call emergency services and shift your child to the nearest hospital for further evaluation.
What happens in a hospital setting?
At the hospital, the main aim is to stop the seizure with anti-seizure medications, intravenous fluid administration to maintain hydration and electrolyte balance, and airway management to aid breathing. Simultaneously, they may conduct tests such as CT/MRI scans or an electroencephalogram (EEG; measures brain wave activity) to identify the cause of the seizure. If a diagnosis is established, the neurologist will design a treatment plan.
What to do after a seizure?
Your child may be sleepy or confused. Let them sleep. If they are awake, ensure they are fully alert and breathing normally before leaving them alone. If your child has bitten his tongue or cheek during the seizure, there may be bleeding. Following the episode, apply gentle pressure to stop the bleeding and clean the area. Check if your child has a fever and give them medication. Call your child’s neurologist to inform them about the episode; they may decide whether the medication needs adjustment.
When to call emergency services?
- Seizures lasting for more than 5 minutes
- Your child experiences a seizure for the first time
- Breathing difficulty
- Lips, face or tongue have a bluish colour
- Injury or fall during an episode
- Lack of responsiveness even after the episode has ended
Also Read: Approach to seizures in children: A comprehensive review
Safety precautions for children prone to seizures
As seizures occur suddenly, the place where they occur, such as in water, stairs or a bathtub, increases the risk of injury or falls. Take the precautions mentioned below to keep your child safe during an episode.
- Prefer showers to bathtubs.
- If your child is old enough to take a shower alone, advise them not to lock the bathroom door.
- Parents should inform teachers about the disease and medication that the child is taking.
- Teachers should know how to recognize seizure and basic management, such as positioning and administering medication.
- Some children may have a decrease in academic performance due to medication or disease. They need extra attention.
- The decision to pursue any sports must be discussed with the doctor.
- Swimming must be prohibited in the absence of adult supervision.
- If your child goes boating, make them wear a life jacket.
- Helmets must be worn while riding a bicycle, and do not allow them to cycle on the streets.
- Climbing more than 10 feet should not be allowed, including bunk beds and ladders.
Overall prognosis and future of a child with epilepsy:
- Almost 60%–70% will attain seizure control easily if compliant with medicines.
- Discuss with the doctor on slowly stopping the medication, if the seizure is controlled for >2 years.
- About 30% may have difficulty with seizure control and other problems like learning difficulties, behavioral and mood problems.
Conclusion
Parents may feel scared or overwhelmed when they see their child experience a seizure for the first time. However, seizures are mostly treatable, and many children may cease to have them over time. As there are different types of seizures, so are the symptoms, ranging from a blank stare to convulsions. Parents must not panic and ensure the safety of their child, protecting them from falls or injury. Seizures usually stop within 5 minutes. Parents must keep a seizure log of the duration, place of occurrence and any noteworthy incident or behavior that preceded or happened during the seizure. This helps the doctor determine the cause/trigger or readjust the medication. If parents are aware of the triggers, they can prevent situations that cause seizure.
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Frequently Asked Questions
- What should I do if my child has a seizure?
Stay calm, turn your child to the side, loosen clothes, and keep sharp objects away. Don’t put anything in their mouth.
- When should I call emergency services during a seizure?
If the seizure lasts more than 5 minutes, it’s their first seizure, or they have breathing issues, call for help immediately.
- Are febrile seizures dangerous?
No, febrile seizures are usually harmless, and children often outgrow them.
- What causes seizures in children?
Seizures can be caused by fever, head injury, infections, low blood sugar, epilepsy, or genetic factors.
- How can I keep my child safe if they have seizures?
Avoid bathtubs, ensure adult supervision while swimming, use helmets while cycling, and inform teachers about their condition.
- Can my child recover from epilepsy?
Yes, around 60–70% of children with epilepsy can manage their seizures well with regular medication. If they stay seizure-free for over 2 years, doctors may gradually stop the treatment.
