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5 Benign Febrile Convulsions Nursing Care Plans
Posted by NursesLabs on October 11, 2011
A febrile seizure is a convulsion in a child triggered by a fever. Such convulsions occur without any underlying brain or spinal cord infection or other neurological cause. According to studies, about 3-5% of otherwise healthy children between the ages of 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Most occur well within the first 24 hours of an illness, not necessarily when the fever is highest.
The first febrile seizure is one of life’s most frightening moments for parents. Most parents are afraid that their child will die or have brain damage. Thankfully, simple febrile seizures are harmless. There is no evidence that simple febrile seizures cause death, brain damage, mental retardation, a decrease in IQ, or learning difficulties. (www.nlm.com) However, a very small percentage of children go on to develop other seizure disorders such as epilepsy later in life.
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1 Hyperthermia
Benign Febrile Convulsion is a convulsion triggered by a rise in body temperature. Fever is not an illness and is an important part of the body’s defense against infection. Antigens or microorganisms cause inflammation and the release of pyrogens which is a substance that induces fever.
Assessment
Nursing Diagnosis
PlanningNursingInterventions
RationaleExpected Outcome
Subjective:
Ө
Objective:
the patient manifested:
> febrile temp = 39°C
Hyperthermia
Short term:
After 4 hours of nursinginterventions, the patient’s temperature will decrease from 39°C to normal range of 36.5°C to 37°C.
Long Term:
After 2 days of nursinginterventio
>Assess underlying condition and body temperature.
>Monitor and recorded vital signs.
>Remove unnecessary clothing that could only aggravate heat.
>Promote adequate rest periods.
>To obtain baseline date.
>To note for progress and evaluate effects of hyperthermia.
>To decrease or totally
Short term:
The patient’s temperature shall have decreased from 39°C to normal range of 36.5°C to 37°C.
Long Term:
>flushed skin and warm to touch
> convulsion
> RR = 34 bpm
the patient may manifest:
> high fever
> weakness
ns, the patient will be able to be free of complications and maintain core temperature within normal range.
>Provide TSB
>Advise to increase fluid intake.
>Loosen clothing.
>Administer IV fluids at prescribed rate. Monitor regulation rate frequently.
>Administer antipyretics as ordered.
diminish pain.
>Reduces metabolic demands or oxygen.
>To promote surface cooling.
>To help decrease body temperature.
>To provide proper ventilation and promote release of heat through evaporation.
>To promote fluid management.
> Antipyretics lower core temperature.
The patient shall have been able to be free of complications and maintain core temperature within normal range.
–~~~~~~~~~~~~–
2 Imbalanced Nutrition
The nutritional requirements of the human body reflect the nutritional intake necessary to maintain optimal body function and to meet the body’s daily energy needs. Malnutrition (literally, “bad nutrition”) is defined as “inadequate nutrition,” and while most people interpret this as undernutrition, falling short of daily nutritional requirements. The etiology of malnutrition includesfactors such as poor food availability and preparation, recurrent infections, and lack of nutritional education.
Assessment
Nursing Diagnosis
PlanningNursingInterventions
RationaleExpected Outcome
Subjective:
Ө
Objective:
the patient manifested:
> body weakness
> weight of 7.9kg
> loss of appetite
> poor muscle tone
the patient may manifest:
> abnormal laboratory studies
Imbalance Nutrition: Less than the body requirement related to economicalfactors.
Short term:
After 4 hours of nursinginterventions, the patient’s will identify measures to promote nutrition and follow the treatment regimen
Long Term:
After 2 days of nursinginterventions, the will demonstrate behaviours or lifestyle changes to regain appropriate weight.
>Review patient’s records.
>Assess underlying condition.
>discuss eating habits and encourage diet for age.
> Note total daily intake includes patterns and time of eating.
>Consult physician for further assessment and recommendation regarding food preferences and nutritional support.
>To obtain baseline data.
>To determine specificinterventions.
>To achieve health needs of the patient with the proper food diet for his disease.
>To reveal change that should be made in the client’s dietary intake.
>For greater understanding and further assessment of specific food.
Short term:
The patient shall have identified measures to promote nutrition and follow the treatment regimen.
Long Term:
The patient shall have demonstrated behaviours or lifestyle changes to regain appropriate weight.
> pallor
–~~~~~~~~~~~~–
3 Ineffective Tissue Perfusion
The circulation to the tissues is not getting enough oxygen or nourishment. Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level.
Assessment
Nursing Diagnosis
Planning NursingInterventions RationaleExpected Outcome
Subjective:
Ө
Objective:
The patient manifested:
>Body temperature changes.
>Skin discoloration
The patient may manifest:
> Anemia
Ineffective tissue perfusion realated to decreased Hgb concentration in blood as evidenced by low Hgb count in CBC result
Short term:
After 4 hours of nursing intervention, the patient will demonstrate behaviour lifestyle changes to improve circulation.
Long term:
After 2 days of nursing intervention, the patient’s S.O. will verbalize understanding of the condition.
> Establish rapport.
> Monitor VS.
> Determinefactors related to individual situation.
> Evaluate for signs of infection especially when immune system is compromised.
> Discuss individual riskfactors.
> Elevate head of bed at night.
> Discuss the importance of a healthy diet..
> To gain patient and S.O.’s trust and promote cooperation.
> To monitor patients status.
> To gain information regarding the condition.
>To observe for possible risk factors.
> This information would be necessary for the client’s S.O.
> To increase
Short term:
The patient shall have demonstrated behaviour lifestyle change.
Long term:
The patient’s S.O. shall have verbalized understanding of the condition.
gravitational blood flow.
>To promote a healthy diet to help increase RBC synthesis and Hgb count for faster recovery.
–~~~~~~~~~~~~–
4 Risk for Infection
The immune system is the body’s defense against bacteria, viruses, and other foreign organisms or harmful chemicals. It is very complex and it has to work properly to protect us from the harmful bacteria and other organisms in the environment which may infect our body. If the immune system is compromised, it can affect the normal production of WBC from the bone marrow. If there is an increase in number of WBC, therefore it may increase the possibility to increase infection.
Assessment
Nursing Diagnosis
PlanningNursingInterventions
RationaleExpected Outcome
S = Ø
O = the patient manifested:
>body weakness
>fatigue
>poor muscle
Risk for (spread) of infection
Short Term:
After 3 hours of nursinginterventions, the patient will verbalize understanding of ways on how to prevent spread of infection.
Long Term:
>Establish good working relationship with the client and S.O.
>Monitor and record vital signs
> Determine pt’s individual strength
>Provide peaceful environment
>To gain their trust and cooperation
>For comparative baseline data
>To know when to
Short Term:
After 3 hours of nursinginterventions, the patient shall have verbalized understanding of ways on how to prevent spread of infection.
tone
=The patient may manifest:
>elevated body temperature
>Hgb = 112
>WBC = 22.9
>RBC = 3.97
>HCT = 0.34
>Platelet count = 234
After 1week of nursinginterventions, the patient will be free from infections and further complications
>Provide adequate rest and sleep.
>Emphasize importance of hand washing
>Provide safety measures
>Monitor I & O
>Check IV and Regulate IVF
>Advice pt to increase oral fluid intake when allowed
assist client
>To promote optimum level of functioning
>To prevent fatigue and conserve energy
>.to prevent occurrence of further infections
>To prevent falls and injuries
>To note for imbalances
>To ensure proper hydration
> To replace fluid electrolyte
Long Term:
After 1week of nursing interventions, the patient shall have been free from infections and further complications.
loss
–~~~~~~~~~~~~–
5 Risk for Injury
A seizure or convulsion is the visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes, such as a high fever and lack of oxygen. Hemoglobin is a protein in red blood cells that carries oxygen. Therefore, Low levels of hemoglobin in the human body may reult to seizure. During episodes of convulsion, patients are prone to injuries since they may strike different objects due to uncontrollable muscle spasms.
Assessment
Nursing Diagnosis
PlanningNursing Interventions
RationaleExpected Outcome
Subjective:
Ө
Objective:
the patient may manifest the following:
>Fever
>Convulsion
>Low
>Low Hgb Level = 112
Risk for injury related to possible convulsion.
Short term:
After 4 hours of nursing interventions, the SO will modify environment as indicated to enhance safety.
Long term:
After 2 days of nursing interventions, the SO will verbalize understanding of individual factors that contribute to possibility of injury.
>establish rapport
>monitor and record Vital Signs
> ascertain knwlge of safety needs/ injury prevention
> note clients gender, age, developmnt stage, decision makng ability, level of cognition/competence
>provide health care within a culture of safety
> identify interventions/safety devices
> discuss importance of self monitoring of conditions/ emotions
> To gain patient’s trust
>To obtain baseline data
> to prevent injuries in home, community, and work setting
>affects client’s ability to protect self/others and influence choice of interventions/ teachings
>to prevent errors resulting in client injury, promote client safety and model
Short term:
The SO shall have modified environment as indicated to enhance safety.
Long term:
The SO shall have verbalized understanding of individual factors that contribute to possibility of injury.
safety behaviors for client/SO
>to promote safe physical environment and individual safety
>it can contribute to occurence of injury
Febrile Convulsions
Seizure: “A clinical event in which there is a sudden disturbance of neurological function in association with an abnormal or excessive neuronal discharge.” (Lissauer, 2002).
A febrile convulsion is a seizure occurring in a child aged from six months to five years, precipitated by a fever arising from infection outside the nervous system in a child who is otherwise neurologically normal. Febrile convulsions have long been recognised, but only in recent years more fully understood. Hippocrates, writing in the 4th century BC, described such a convulsion, clearly differentiating it from rigors and breath holding attacks. He noted that both generalised and partial seizures can occur, and realised that there was a strong association with age, high fever and a precipitating infection. (Great Ormond Street Hospital for Children NHS Trust).
Febrile convulsions are a common paediatric presentation to A&E departments, occurring in about 3% of children between the ages of six months and five years. The seizure usually occurs early on in a viral infection when the temperature is rising rapidly, and typically lasts less than five minutes. It is the abrupt rise in temperature rather than the high level that is important. The seizures are tonic or tonic-clonic, with loss of consciousness and muscular rigidity forming the tonic stage. This may be preceded by a frightened cry from the child. Cessation of respiratory movements and incontinence of urine and faeces may
occur during this stage, which lasts about 30 seconds. The clonic stage that follows is characterised by repetitive movements of the limbs and face.
Management of the fitting febrile child:
Clothing should be removed and the child covered with a sheet.The child should be placed on its side, or prone with its head to one side, since vomiting with aspiration is a hazard.Rectal diazepam is the drug of choice, producing an effective blood concentration of anticonvulsant within ten minutes.All children with a first febrile convulsion should be admitted to hospital to a) exclude meningitis and b) educate the parents.A urine specimen should be taken to exclude infection, and a blood glucose level should be taken.A lumbar puncture may be performed if the child is less than eighteen months old shows signs of meningitis or sepsis.
Treatment of the febrile child:
Fever should be treated to promote the comfort of the child and to prevent dehydration. Paracetamol is the preferred anti-pyretic and fluid levels should be maintained. Ibuprofen can be given if the fever does not respond to paracetamol.Rectal diazepam should be administered as soon as possible after the start of the convulsion, and should not be given after the convulsion has stopped.
Information should be supplied by the hospital to parents, explaining the nature of febrile convulsions, including information about the prevalence and prognosis. Parents should be instructed on the management of fever, the management of a convulsion and the administration of rectal diazepam. Finally, they should be reassured. During further febrile illnesses, parents should be advised to keep the childs temperature low, by removing warm clothing, tepid sponging and giving an antipyretic (paracetamol or ibuprofen) such as Calpol. Parents of children with an increased risk of seizure recurrence should be supplied with rectal diazepam to administer for any further seizure lasting more than five minutes. Parents should receive written as well as verbal advice on the first aid management of a further convulsion. Following convulsion, a doctor should always be consulted in order to
determine that the cause is simply a viral infection, and not something more serious such as meningitis.
The overall risk of a further febrile convulsion is one in three, but the recurrence risk is higher if the first seizure occurs before one year of age and there is a positive family history. There is also a greater risk of recurrence if the first convulsion occurs at a relatively low body temperature, below 39°C. The chance of having another febrile convulsion in the following year is 30%. The risk of a second fit reduces every year and it becomes extremely rare after the child turns 6 years old. (NSW Health). A history of febrile convulsions in a first degree relative is associated with a recurrence risk of about 50%. If either parent suffered a febrile convulsion as a child, the risk of the child suffering one rises 10 to 20 per cent. If both parents and their child have at some point suffered a febrile convulsion, the risk of another child getting it rises 20 to 30 per cent. (Netdoctor). It is rare for any child to suffer recurrent febrile convulsions after the age of four years.
One in a thousand children may suffer a febrile convulsion after receiving the MMR vaccine. In these cases it occurs 8 to 10 days after the vaccination and is caused by the measles component of the vaccine. However, this causes only about one tenth of cases of febrile convulsion compared with measles itself. (Netdoctor). Children who are prone to febrile convulsions should follow the same programme of vaccination as all other children.
A family history of epilepsy is also associated with an increase in the risk of further febrile convulsions. It must be pointed out though that febrile convulsions are not epileptic fits. Febrile convulsions usually have a benign prognosis, but approximately 1% will go on to develop epilepsy in later life. Risk factors for the subsequent development of partial epilepsy are a prolonged seizure (longer than 30 minutes) or if seizures recur within the same illness.
References
Lissauer, T. & Clayden, G., Illustrated Textbook of Paediatrics, (Second Edition). Elsevier Science Ltd 2002.
Febrile seizure
A febrile seizure, also known as a fever fit or febrile convulsion, is a convulsion associated with a significant rise in body temperature. They most commonly occur in children between the ages of 6 months and 6 years and are twice as common in boys as in girls.[1][2]
Causes
The direct cause of a febrile seizure is not known; however, it is normally precipitated by a
recent upper respiratory infection or gastroenteritis. A febrile seizure is the effect of a
sudden rise in temperature (>39°C/102°F) rather than a fever that has been present for a
prolonged length of time.[2] As well as this, parents caring for children who may be febrile,
wrap them up in warm blankets in an attempt to comfort the child, unknowingly increasing
their fever and therefore the problem.
Febrile seizures occurring in children between the ages of 6 months and about 6 years can
be due to a hypersensitive hypothalamus in the brain. The hypothalamus is responsible for
homeostatic core temperature regulation, (amongst other factors) and in younger children
it is still a developing portion of the brain, meaning it is susceptible to hypersensitive
reactions to slight raises in body temperature.
Febrile seizures represent the meeting point between a low seizure threshold (genetically
and age-determined; some children have a greater tendency to have seizures under certain
circumstances) and a trigger, which is fever. The genetic causes of febrile seizures are still
being researched. Some mutations that cause a neuronal hyperexcitability (and could be
responsible for febrile seizures) have already been discovered.[citation needed]
Several genetic associations have been identified.[3] These include:
Type OMIM Gene
FEB3A
604403 SCN1A
FEB3B 604403 SCN9A
FEB4 604352 GPR98
FEB8 611277 GABRG2
Certain forms are considered channelopathies.[4]
[edit]Diagnosis
The diagnosis is one that must be arrived at by eliminating more serious causes
of seizure and fever: in particular, meningitis and encephalitis must be considered.
However, in locales in which children are immunized for pneumococcal and Haemophilus
influenzae, the prevalence of bacterial meningitis is low. If a child has recovered and is
acting normally, bacterial meningitis is very unlikely. The diagnosis of a febrile seizure
should not prevent evaluation of the child for source of fever, although this is usually
limited to evaluation of the urine in the younger age groups.
[edit]Types
There are two types of febrile seizures.
A simple febrile seizure is one in which the seizure lasts less than 15 minutes (usually
much less than this), does not recur in 24 hours, and involves the entire body
(classically a generalizedtonic-clonic seizure).
A complex febrile seizure is characterized by longer duration, recurrence, or focus on
only part of the body.
The simple seizure represents the majority of cases and is considered to be less of a cause
for concern than the complex.[citation needed]
Simple febrile seizures do not cause permanent brain injury; do not tend to recur
frequently (children tend to outgrow them); and do not make the development of
adult epilepsy significantly more likely (about 3–5%), compared with the general public
(1%).[5] Children with [6] febrile convulsions are more likely to suffer from a febrile epileptic
attacks in the future if they have a complex febrile seizure, afamily history of a febrile
convulsions in first-degree relatives (a parent or sibling), or a preconvulsion history of
abnormal neurological signs or developmental delay. There is an 80% chance that children
who have complex febrile seizures will have seizures later on in life. Similarly,
the prognosis after a simple febrile seizure is excellent, whereas an increased risk of
death has been shown for complex febrile seizures, partly related to underlying conditions.[7]
[edit]Symptoms
During simple febrile seizures, the body will become stiff and the arms and legs will begin
twitching. The patient loses consciousness, although their eyes remain open. Breathing can
be irregular. They may become incontinent (wet or soil themselves); they may also vomit
or have increased secretions (foam at the mouth). The seizure normally lasts for less than
five minutes.[8]
[edit]Treatment
The vast majority of patients do not require treatment for either their acute presentation
with a seizure or for recurrences. The best way to manage is to control the temperature
with acetaminophen (Paracetamol) or by sponging. When anticonvulsant therapy is judged
by a doctor to be indicated, anticonvulsants can be prescribed. Sodium
valproate or clonazepam are active against febrile seizures, with sodium valproate showing
superiority over clonazepam.[9]
Febrile Convulsion
See also:
Convulsions and Febrile Child guidelines
The approach to febrile convulsions requires dealing with- the convulsion- the illness causing the fever.
Background to condition:
Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection.
They
occur in 3% of health children are normally associated with simple viral infection are benign Simple febrile convulsions:
These are generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness.
Complex febrile convulsions:
These have one or more of the following:
- focal features at onset or during the seizure- Duration of more than 15 minutes- Recurrence within the same febrile illness- Incomplete recovery within 1 hour.
Febrile status epilepticus
This is a febrile convulsion lasting for longer than 30 minutes.
Note:It is now recognised that some children can have a presentation with convulsions and an acute infectious illness (particularly gastroenteritis) without documented fever. This is sometimes referred to as " afebrile febrile convulsions". The management and prognosis is the same as for classical febrile convulsions.
Acute Management:
Treat the convulsion when necessary as per Convulsions guidelines.
* Reassurance is important in simple febrile convulsions. The onset of the convulsion may be sudden with little evidence of preceding illness. The convulsion may be terrifying for the parents to observe they frequently believe that their child is dying and may attempt CPR or other resuscitative measures.
Fever control
Paracetamol has NOT been shown to reduce the risk of further febrile convulsions. It may be used for pain / discomfort associated with febrile illnesses such as otitis media. The parents should understand the reasons for its use and be discouraged from using it solely to reduce their child's fever.
Assessment:
In a simple febrile convulsion once the convulsion has terminated, the aim of the assessment is to determine the cause of the fever.
History and Examination as per Febrile Child guidelines.
In addition, look for the following risk factors which make simple febrile convulsion unlikely:
- previous afebrile seizures- progressive neurological conditions- signs of CNS infection
Investigations:
In a simple febrile convulsion, where the focus of infection can be identified, blood tests and invasive investigations are often NOT indicated.
In a child less than 6 months of age reconsider your diagnosis, especially the possibility of CNS infection (meningitis guideline).
Consider LP if the child is less than 12 months and not up to date with immunisations (especially Hib and pneumococcal), if they are clinically unwell, or if they are already on oral antibiotics that may mask meningitis. Discuss these children with a senior clinician. If
there is a genuine contraindication then antibiotic cover appropriate for meningitis should be commenced.
Consider consultation with local paediatric team when:
- Complex febrile convulsion.- Seizures unable to be controlled.- Child does not return to normal mental state within 1 hour- Child clinically unwell.- Ongoing concern regarding the nature of the febrile illness. (febrile child guideline)
Consider transfer when:
- Respiratory or haemodynamic compromise.- Children requiring care above the level of comfort of the local hospital.
For ICU level transfer ring the NETS/PETS Hotline: (03) 9345 7007
Discharge requirements:
- Return to normal neurological state following simple febrile convulsion- Serious bacterial infection excluded or adequately treated- Parental education regarding febrile convulsions
If discharging a patient home following a febrile convulsion, it is important to give the family advice regarding what to do in the event of a future convulsion.- Verbal advice should be reinforced with written advice (give Parent Information Sheet - see below).- Follow-up during as appropriate for the underlying illness.
Parent information sheet:
Information Specific to RCH
If admitted, children with a febrile convulsion are usually admitted under the General Paediatric Team.
Discuss with consultant or senior registrar children with complex febrile convulsions or those in whom LP is being considered.
Additional Notes
Long term issues with febrile convulsions.
Recurrence rate depends on the age of the child; the younger the child at the time of the initial convulsion, the greater the risk a further febrile convulsion (1 year old 50%; 2 years old 30%).
Risk of future afebrile convulsions (epilepsy) is increased by family history of epilepsy, any neurodevelopmental problem, atypical febrile convulsions (prolonged or focal). No risk factors: risk of subsequent epilepsy approx. 1% (similar to
population risk). 1 risk factor: 2%. More than 1 risk factor: 10%.
Long term anticonvulsants are not indicated except in rare situations with frequent recurrences.
It may be appropriate to offer a review appointment with a general paediatrician, especially in the case of complex febrile convulsions.
PathophysiologyFebrile seizures are dependent upon a threshold temperature or the height of the body
temperature. [14] [20] [21] The rate of body temperature rise as a cause is a frequently held theory, but this is
unsupported by more recent laboratory and clinical studies. [22] A specific neurotropism or CNS-invasive property of
certain viruses (e.g., human herpesvirus-6 (HHV-6), influenza A), and bacterial neurotoxin (Shigella dysenteriae) has
been implicated, but the evidence is inconclusive. [13] [16] In some cases, HHV-6 may invade the brain during the
acute viraemic phase of exanthem subitum. Exanthem subitum, otherwise known as roseola or sixth disease, is a
febrile illness often accompanied by a rash, lymphadenopathy, and GI or respiratory symptoms. Seizure recurrence
may be associated with reactivation of the HHV-6 virus. The definition of febrile seizure may need to be modified to
include a mild encephalitis or encephalopathy in these cases. The type - simple or complex - may be related to a viral
neurotropism or to the severity of a cytokine immune response to infection
Background
Febrile seizures are the most common seizure disorder in childhood. Since early in the 20th century, people have debated about whether these children would benefit from daily anticonvulsant therapy. Epidemiologic studies have led to the division of febrile seizures into 3 groups, as follows: simple febrile seizures, complex febrile seizures, and symptomatic febrile seizures.
Simple febrile seizure
The setting is fever in a child aged 6 months to 5 years. The single seizure is generalized and lasts less than 15 minutes. The child is otherwise neurologically healthy and without neurological abnormality by examination or by
developmental history. Fever (and seizure) is not caused by meningitis, encephalitis, or other illness affecting the brain.
Complex febrile seizure
Age, neurological status before the illness, and fever are the same as for simple febrile seizure. This seizure is either focal or prolonged (ie, >15 min), or multiple seizures occur in close succession.
Symptomatic febrile seizure
Age and fever are the same as for simple febrile seizure. The child has a preexisting neurological abnormality or acute illness.
Pathophysiology
This is a unique form of epilepsy that occurs in early childhood and only in association with an elevation of temperature. The underlying pathophysiology is unknown, but genetic predisposition clearly contributes to the occurrence of this disorder.[1]
Epidemiology
Frequency
United StatesFebrile seizures occur in 2-5% of children aged 6 months to 5 years in industrialized countries. Among children with febrile seizures, about 70-75% have only simple febrile seizures, another 20-25% have complex febrile seizures, and about 5% have symptomatic febrile seizures.
Mortality/Morbidity
Children with a previous simple febrile seizure are at increased risk of recurrent febrile seizures; this occurs in approximately one third of cases.
Children younger than 12 months at the time of their first simple febrile seizure have a 50% probability of having a second seizure. After 12 months, the probability decreases to 30%.
Children who have simple febrile seizures are at an increased risk for epilepsy. The rate of epilepsy by age 25 years is approximately 2.4%, which is about twice the risk in the general population.
The literature does not support the hypothesis that simple febrile seizures lower intelligence (ie, cause a learning disability) or are associated with increased mortality[2] .Sex
Males have a slightly (but definite) higher incidence of febrile seizures.
Age
Simple febrile seizures occur most commonly in children aged 6 months to 5 years.
History
Children with simple febrile seizures are neurologically and developmentally healthy before and after the seizure.
They do not experience a seizure in the absence of fever. The seizure is described as either a generalized clonic or a generalized tonic-clonic seizure.
Signs of a focal seizure during the onset or in the postictal period (eg, initial clonic movements of 1 limb or of the limbs on 1 side, a weak limb postictally) would rule out a simple febrile seizure.
Similarly, simple febrile seizure activity does not continue for more than 15 minutes, although a postictal period of sleepiness or confusion can extend beyond the 15-minute maximum.
Simple febrile seizures often occur with the initial temperature elevation at the onset of illness. The seizure may be the first indication that the child is ill. While no clear cutoff is known, a rectal temperature under 38°C should raise concern that the event was not a simple febrile seizure.
Physical
Physical examination findings reveal a neurologically and developmentally healthy child. It is especially important that the child have no signs of meningitis or encephalitis (eg, stiff neck or persistent mental status changes).
Causes
Simple febrile seizures are considered a genetic disorder, but neither a specific locus nor a specific pattern of inheritance has been described. The mode of inheritance is likely to vary between families and may be multifactorial.
Differentials
Acute Disseminated Encephalomyelitis Acute Stroke Management Anterior Circulation Stroke Aseptic Meningitis Basilar Artery Thrombosis Benign Childhood Epilepsy Complex Partial Seizures First Seizure: Pediatric Perspective Meningococcal Meningitis Neonatal Meningitis Neonatal Seizures Partial Epilepsies Posterior Cerebral Artery Stroke Seizures and Epilepsy: Overview and Classification Simple Partial Seizures Tonic-Clonic Seizures Viral Encephalitis Viral Meningitis
Laboratory Studies
No specific studies are indicated for a simple febrile seizure. Physicians should focus on diagnosing the cause of fever. Other laboratory tests may be indicated by the nature of the underlying febrile illness. For example, a
child with severe diarrhea may benefit from blood studies for electrolytes.
Imaging Studies
Neither computed tomography (CT) nor magnetic resonance imaging (MRI) is indicated in patients with simple febrile seizures.
Other Tests
EEG is not indicated in children with simple febrile seizures. Published studies demonstrate that the vast majority of these children have a normal EEG. In addition, some of those with an abnormal EEG have remained free of seizures for the duration of their follow-up. On the other hand, some of the children with a normal initial EEG have experienced 1 or more afebrile seizures subsequent to the EEG. Finally, no evidence indicates that beginning anticonvulsant therapy for a child with simple febrile seizures and an abnormal EEG will alter the child's eventual outcome.
Procedures
Strongly consider lumbar puncture in children younger than 12 months, because the signs and symptoms of bacterial meningitis may be minimal or absent in this age group.
Lumbar puncture should be considered in children aged 12-18 months, because clinical signs and symptoms of bacterial meningitis may be subtle in this age group.
In children older than 18 months, the decision to perform lumbar puncture rests on the clinical suspicion of meningitis.Medical Care
On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures.
Continuous therapy with phenobarbital or valproate decreases the occurrence of subsequent febrile seizures.
o Both therapies confer significant risks and potential adverse effects, whereas additional simple febrile seizures have no proven risk.
o These medications are not recommended, since the potential benefits do not outweigh the potential risks.
No evidence suggests that any therapy administered after a first simple seizure will reduce the risk of a subsequent afebrile seizure or the risk of recurrent afebrile seizures (ie, epilepsy).
Oral diazepam can reduce the risk of subsequent febrile seizures. Because it is intermittent, this therapy probably has the fewest adverse effects. If preventing subsequent febrile seizures is essential, this would be the treatment of choice.[3]
Although it does not prevent simple febrile seizures, antipyretic therapy is desirable for other reasons.Medication Summary
On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures. In unusual circumstances, oral diazepam can be given with each fever.
