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the last very benign type of seizure
I'll discuss is febrile seizures these
are incredibly common this is the most
common cause of seizures in children and
it's by far and it's the typical febrile
seizure we define a typical febrile
seizure for a very good reason and
that's because if you detect it you need
to do no work up at all
by definition a febrile seizure must
occur between age six months and six
years the child must have a fever either
during or just after the seizure
remember it's not the temperature that's
causing the seizure it's actually the
inflammatory cytokines such as
interleukin 1 that are causing the
seizure in the brain so the fever may be
slightly delayed after the seizure in
fact it commonly is so they just have to
have a fever around that time the
episode should last less than 15 minutes
and they should have only one episode in
the 24-hour period and it should be a
generalized seizure a focal seizure is
not a febrile seizure if the child meets
all of these criteria this is a typical
febrile seizure and no workup is
necessary for many of us in the care of
children if we see this child recover
and looking better we're gonna send them
home without doing anything we may even
do that in some children who are very
reassuring appearing and have a high
fever if they violate some of these
criteria the one I allow violating the
most is one episode in 24 hours it's
common for febrile seizures to violate
that and for there to be two or three
quick febrile seizures a typical febrile
seizures are those seizures that violate
one of these rules but are still
continued to be a febrile seizure and so
children with atypical febrile seizures
usually might get a brief workup or a
look around to see what's going on but
we won't worry about it of course if the
child has a cause of fever that it's
you might need to treat the underlying
infection or cause what's key about
febrile seizures is that antipyretics
don't prevent them in other words
telling families use ibuprofen every
time your child gets a fever we want to
prevent seizures will not work in fact
in children who've received that
counseling they have the same number of
seizures as children who don't so there
are no negative consequences to these
seizures it's not going to be a problem
but you should counsel families about a
few things first they do run in families
in fact don't be surprised if at the end
of the visit somebody fesses up that
when they were a kid they also had
seizures another thing to counsel
families about is that these are benign
entities and the question in every
parents brain that that's burning in the
back of their head is did this caused
brain damage you should come out and
tell them their child's gonna be just
fine
the last thing to worry about is that
they can come back one third of children
who prevent was present with febrile
seizures will have another before they
outgrow them around the age of six years
of age if the first febrile seizure was
before the age of one that risk
increases to 50% so when you're seeing a
family who's come in with a child who's
had a first febrile seizure it's
important to counsel them about what to
do if it happens again here's what to do
if it happens again
first make sure that child is safe
obviously if they're a near a fireplace
or in a swimming pool we have to pull
them to a safe location
next tell the family to check their
watch this is the last thing a family is
going to do when their child is seizing
but knowing how long a seizure has gone
on is very important deciding what we
need to do to fix it so tell the family
to check the time if the seizure lasts
more than five minutes the family should
call 911 their car and drive at a
hundred miles an hour to the nearest ER
because if God forbid they had an
they would now have an accident and a
seizing child in the backseat so the
other reason to call 911 United States
an ambulance is available probably
within five to ten minutes of every
house in the United States as a result
it's important to recognize that the
ambulance brings with it usually
anti-seizure medications like
benzodiazepines so the seizure can
actually be stopped faster by calling
9-1-1 than by rushing to the hospital
if a child is cyanotic or blue during a
seizure the parent should call 9-1-1
even if it's only been two minutes that
child has respiratory suppression but
keep in mind cyanosis and febrile
seizure is very rare circumcise OSIS can
happen but that's not necessarily from
hypoventilation or hypoxia that could be
from increased vascular tone in the lips
causing a decreased perfusion from an
adrenal response to the seizure
if the seizure is resolved within 5
minute period and the child never had
cyanosis and this is the vast majority
they can just take that child to be
evaluated by the pediatrician or a local
ER if the pediatricians office is closed
within the next few hours just to make
sure there's not something more going on
and to make sure that child's fever is
taken care of and it it doesn't reveal
some sort of more important underlying
infection remember and this is key and
might be asked one third of children
will have another seizure before they
outgrow febrile seizures and half will
have a seizure if their first seizure is
within the first 12 months thanks for
your attention
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you