Febrile convulsions in children

About two to five percent of all children between the age of six months and five years suffer from so-called fever cramps. Such a seizure looks frightening: The child twists its eyes, the lips turn blue, it twitches rhythmically or falls into a short unconsciousness.

The seizure is usually spontaneous after an average of five minutes and the child then recovers quickly. In rare cases, however, the seizure can also last longer than 15 minutes and may have to be stopped by medication.

The symptoms of febrile spasms are similar to a mild epileptic seizure, which is why they are medically classified there. However, in 2010, the International League Against Epilepsy first named fever cramps as an independent syndrome, which should not be classified as epilepsy. Fever cramps are not caused by a disease of the brain, such as epileptic seizures, but by inflammation in the body. This is usually a viral respiratory tract infection in the context of a cold or flu, but often also a bacterial infection, such as inflammation of the middle ear or pneumonia. The body defends itself with fever - a good way to combat pathogens. However, a rapid increase in the core temperature may cause the excitability threshold of the cerebral cortex to fall. The brain becomes more easily excitable or overexcitable, which can be shown in the form of cramps. Many febrile convulsions therefore occur at the first rise of fever as part of a banal infection. They can also occur when the temperature drops again.

If your child is in such a cramping situation, it is important to keep calm. Loosen his clothes so he can breathe freely. Please do not inject any medication or liquids into the child, otherwise there is a risk of suffocation. It is also not helpful to try to calm the child with cold water, the cold stimulus could rather intensify the arousal of the brain. It is best to inform a doctor or an emergency physician immediately. Even if the seizure is already over, you should seek medical help, because in individual cases it could be a so-called complicated fever cramp. This lasts longer than the simple fever cramp and is also detectable in the brain after the attack by measuring the electrical currents of the brain, the so-called EEG.

In order to distinguish the simple from the complicated fever cramp, the children are usually admitted to hospital for further monitoring, especially if they are still under 18 months old. Here it is also clarified whether an epileptic seizure or an inflammatory disease of the meninges or the brain is the cause, which leads to a special treatment. If the simple fever cramp reappears in the hospital, a drug containing the active substance benzodiazepine is administered in the vast majority of cases with a seizure duration of more than three minutes. The medication is either placed in the cheek where it is absorbed through the mucous membranes or is introduced rectally as suppositories. The amount of active ingredients depends on your child's body weight. Affected parents are referred to this emergency medication so that they can quickly find the right medication when a seizure recurs.

By the way, it is not advisable to give a fever-reducing medication for prevention. The reduction of fever is an important part of improving the wellbeing of the feverish child and therefore makes sense in case of a high fever. But an early fever reduction does not help to reduce the risk of another fever cramp. This means that you do not have to constantly measure your child's body temperature, even with a harmless snuff nose.

Our conclusion: Fever cramps look dangerous - but as a rule they do not have any health consequences for the child. In medical literature, no deaths have so far been described as the result of a fever cramp. The shorter the seizure, the quicker the children will regain consciousness. However, after prolonged cramps, many children fall into a sleep from which they wake up somewhat beaten up. Many parents have the understandable concern that their child may suffer permanent brain damage from the seizure, but this concern is usually unfounded.

Copyright: Landeszentrale fuer Gesundheitsfoerderung in Rheinland-Pfalz e.V. (LZG) Germany

Text: Dr. Beatrice Wagner

Editorial Office: Marielle Becker