A very common and frightening condition of young childhood is benign febrile seizures (BFS), defined as a seizure episode associated with febrile illness not involving the brain. This condition effects 2-5% of children ages 6 mo-6 years, predominantly those under 18 months. They are more typically of short duration(< 10 minutes) and “generalized,” meaning the child will briefly loose consciousness and the entire body will shake.
Febrile seizures are usually simple–lasting no more than 15 minutes (usually no more than a minute or 2) and subsequently the child will wake up and be fairly alert. “Complex” febrile seizures are longer, may be multiple during one illness, and/or display “focality”–predominantly one limb or one side shakes. The most important word in the above diagnosis name is BENIGN. They do not seem to have risks of serious neurologic disorders compared to others-problems like ADHD, hearing deficits, learning problems or developmental delay. 2-10% will develop epilepsy, about the same as the general population. Those with “complex” febrile seizures, those with developmental delay or underlying neurologic problems like cerebral palsy do, unfortunately, have a somewhat greater risk here. In these instances, the seizure episode is felt to be more a marker as a tendency towards epilepsy as opposed to merely an isolated event.
Most children with BFS will only experience a seizure episode a very few times–only 1/3 will have more than 1, and fewer than 10% have more than 3. Children who are less than 15 mo old, have frequent fevers, family history of epilepsy or febrile seizures, short time between onset of fever and seizure, or seizure with lower level of fever make up the cohort at risk for more frequent occurrences.
Children with BFS should receive more aggressive fever control during acute illnesses. Keep ibuprofen available, as well as acetaminophen for both oral and rectal administration –in case the child will not or cannot take medicine orally(say, during a seizure). Tepid baths, cool liquids to drink, appropriate light clothing are all helpful. Acute use of anti-seizure medicine is occasionally employed but mostly we try to avoid that route, at least for those in the “simple” benign febrile seizure category. The incidence of complications from these medicines, while quite low, is still higher for most BFS children, and, as we doctors say, “the cure should never be worse than the disease.” Use of these medicines daily to control the problem is reserved for those with complex febrile seizures under the care of a child neurologist.
Though certainly terrifying to witness, parents should try and keep in mind that in the very large majority of children with BFS this disorder will just go away in time and their child will grow up healthy and normal. If you have questions or concerns about benign febrile seizures and your child be sure to contact me, and thanks for following.