Febrile Seizures: A Comprehensive Guide for Nurses

Febrile seizures are convulsions triggered by fever in young children, typically occurring in the absence of an underlying neurological condition. While generally benign, febrile seizures can be alarming for parents and caregivers. Nurses play a crucial role in managing the acute episode, educating families, and alleviating concerns.

Definition

Febrile seizures are categorized as seizures associated with fever (≥38°C or 100.4°F) in children aged 6 months to 5 years without a prior history of afebrile seizures, central nervous system infections, or metabolic abnormalities.

Types of Febrile Seizures

Simple Febrile Seizures:

• Generalized tonic-clonic activity.
• Lasts <15 minutes.
• Occurs once within a 24-hour period.
• No postictal neurological abnormalities.

Complex Febrile Seizures:

• May have focal onset or features.
• Lasts >15 minutes.
• Recurs more than once within 24 hours.
• May have transient postictal neurological deficits (e.g., Todd’s paralysis).

Epidemiology

• Occurs in 2-5% of children.
• Most common between 6 months and 3 years of age.
• Equal incidence in boys and girls.
• Strong familial predisposition, with increased risk in siblings or offspring of affected individuals.

Causes and Risk Factors

1. Causes:

• Fever from viral infections (e.g., influenza, roseola).
• Bacterial infections (e.g., otitis media, pneumonia).
• Post-immunization reactions (e.g., after MMR vaccine).

2. Risk Factors:

• Family history of febrile seizures or epilepsy.
• Rapid rise in body temperature.
• Age between 6 months and 3 years.
• Previous history of febrile seizures.

Clinical Presentation

Symptoms:

During the Seizure:

• Sudden loss of consciousness.
• Generalized jerking or stiffening (tonic-clonic movements).
• Rolling of eyes or staring.
• Cyanosis or apnea in severe cases.

After the Seizure:

• Postictal drowsiness or confusion.
• Quick return to baseline for simple febrile seizures.

Severe Symptoms (Signs of Kernicterus):

• High-pitched crying.
• Hypotonia or hypertonia.
• Arching of the neck and back (retrocollis/opisthotonos).
• Seizures.
• Poor feeding or refusal to feed.

Diagnosis

Febrile seizures are primarily diagnosed based on clinical history and presentation. Further investigations are required to rule out underlying causes.

1. Clinical Assessment:

Detailed History of the Seizure:

• Onset, duration, type.

Fever History:

• Onset, height of fever.

Neurological Examination:

• Assess postictal state.

2. Laboratory Tests:

• Blood Work: If infection or metabolic disturbances are suspected.
• Complete Blood Count (CBC): Leukocytosis.
• Blood Type and Coombs Test: For hemolytic causes.

3. Neuroimaging (Rarely Needed):

• Consider head CT or MRI for complex febrile seizures or if neurological abnormalities persist.

4. Electroencephalogram (EEG):

• Not routinely recommended after a simple febrile seizure.
• May be considered for atypical or recurrent seizures.

Management of Febrile Seizures

Goals of Treatment:

• Terminate the seizure.
• Identify and treat the underlying cause of fever.
• Educate and reassure caregivers.

1. Acute Management:

Positioning:

• Place the child in a side-lying position to prevent aspiration.

Seizure Precautions:

• Do not place objects in the child’s mouth.
• Avoid restraining the child during the seizure.

Medications:

• If the seizure lasts >5 minutes, administer benzodiazepines:
• Rectal diazepam (0.2–0.5 mg/kg).
• Intranasal or buccal midazolam (0.2 mg/kg).

Monitor:

• Vital signs, oxygen saturation, and duration of the seizure.

2. Post-Seizure Care:

• Reassure caregivers as the child regains consciousness.
• Administer antipyretics (e.g., acetaminophen, ibuprofen) to reduce fever.
• Address the underlying cause of fever (e.g., antibiotics for bacterial infections).

Nursing Interventions

1. Assessment and Monitoring:

• Document seizure characteristics (duration, type, postictal state).
• Monitor vital signs and temperature regularly.
• Evaluate for signs of underlying infections (e.g., respiratory distress, rash).

2. Caregiver Education:

• Teach parents seizure first aid:
• Keep the child safe during a seizure.
• Time the seizure and seek medical attention if it lasts >5 minutes.
• Explain the generally benign nature of febrile seizures and low risk of epilepsy.
• Provide guidance on fever management:
• Administer antipyretics promptly.
• Encourage adequate hydration.

3. Emotional Support:

• Address parental anxiety and provide reassurance.
• Encourage open communication and answer questions.

4. Preventive Measures:

• Discuss the use of antipyretics during febrile illnesses.
• Emphasize the importance of seeking medical care for recurrent seizures or prolonged fever.

Complications of Febrile Seizures

Risk of Recurrence:

• Occurs in 30-40% of children, especially if:
• First seizure occurred before age 1.
• Family history of febrile seizures.
• Most recurrences occur within 1 year of the first episode.

Risk of Epilepsy:

• Slightly higher in children with complex febrile seizures.
• Overall risk: ~2-5%, compared to 1% in the general population.

Parental Anxiety:

• Fear of future seizures or misunderstanding the benign nature of febrile seizures.

Prevention of Febrile Seizures

Fever Management:

• Use antipyretics during febrile illnesses.
• Keep the child hydrated and monitor for worsening symptoms.

Education:

• Provide clear instructions on when to seek medical care.
• Educate on the low risk of complications associated with febrile seizures.

Preventive Medications:

• Long-term anticonvulsants (e.g., phenobarbital, valproic acid) are rarely indicated due to side effects and the benign nature of febrile seizures.

Conclusion

Febrile seizures are common and typically benign in young children. Nurses are instrumental in managing acute episodes, educating caregivers, and providing emotional support to alleviate concerns. Through prompt assessment, effective intervention, and clear communication, nurses can ensure the safety and well-being of the child while empowering families to manage febrile seizures confidently.