Convulsions in little children mostly due to fever, calls for concern —Expert

Fevers can cause a child to experience spasms or jerky movements called seizures. Seizures, a convulsion caused by fever also called “febrile seizures” are most common with fevers of 102°F (38.9°C) or higher, but they can also happen at lower body temperatures or when a fever is going down. Most febrile seizures last for less than one or two minutes.

Fever-related seizures in young children can be alarming for parents, but they’re usually not life-threatening. During a so-called febrile seizure, a child may lose consciousness, experience body stiffness and have full-body shaking.

The seizures, which rarely require medication, majorly might not require hospitalization when it is due to a raised body temperature and not a disease, according to Dr Joy Alejo, a paediatric neurologist at University College Hospital, Ibadan.

According to Dr Alejo, “Generally, when someone has a fever, usually there’s an underlying problem. Many things can cause a fever, not just malaria and children generally always have febrile episodes. Children, who are between three months to five years, have been found to tend to have seizures when their temperature is raised and there are a lot of theories around it.

“The brain is not fully mature until 5 years of age. So, during that time, when the brain is still growing, its ability to kind of manage itself in the presence of fever is not fully matured. So, if a child has a high temperature from anything, he can have a seizure. And so it may just be a common cold, and the temperature goes up. The child could convulse.

“The usual type of febrile convulsion is the simple one. There are two types, we have the simple and we have the complex. So in the simple one, usually the child will just have one episode of seizure once that day. Once the seizure happens, the child will calm down and there will be no other problem.

“These febrile convulsions are specific to that age group and then they outgrow it. Some children are like that, but once they get to 5 years of age, that is the end of it because by that time the brain has matured. So usually it is not particularly troublesome parse but of course, when you see a child convulsing, it is something to worry about.”

Dr Alejo stated that there is strong evidence suggesting that convulsion in children below 5 years may also be genetic.

She added: “Some families, you hear of a father who used to have convulsions whenever he has a fever, he will have a son or daughter and the child will also be having it but we believe that there is some kind of inheritance in it.

“Some people had said deficiencies in some micronutrients also can be a reason for a child convulsing, but the evidence on this is not very strong. What we know is that it happens in this age group; there is this familiar or genetic tendency to it and then they outgrow it.”

However, Dr Alejo said no febrile convulsion could be termed a simple one until investigations are done to rule out other sinister things that can cause convulsion in children such as meningitis and cerebral malaria.

Seizures due to diseases such as meningitis and severe malaria are complex ones. It affects only a part of the body, last more than 15 minutes or recurs within 24 hours and has a slightly higher rate of future complications.

Doctors examining such a child because they were not there when the seizure happened will ask questions such as, how long the seizure lasted, body stiffening, twitching of the face, arms and legs, staring, loss of consciousness, whether the child recovered within one hour or whether they’ve had a seizure before.

Further testing and observation in the hospital are also usually recommended if the child’s symptoms are unusual or they’re having complex febrile seizures, particularly in children younger than 12 months. The tests that are required may include an electroencephalogram (EEG), which measures the child’s electrical brain activity by placing electrodes on their scalp.

Howbeit, she said that preventing a reoccurrence of febrile seizure is important in children because once a child has had one episode of febrile seizure, it is likely that it will happen again whenever he has a fever, especially if the child is within that age group.

Dr Alejo declared: “So the easiest thing will be to not let your child have a high fever. Such a mother should always have medicines like paracetamol that control body temperature at home and give if that child has a fever for any reason and immediately afterwards take to the hospital to be sure that there is nothing.”

She stated that forcing any liquid, including herbal concoction into the mouth of a child convulsing, putting a spoon in the mouth or putting the child on a chair or holding him to the chest rather than allowing the child to lie on his left side on the floor are dangerous practices that could be life-threatening in a child that is having a seizure.

During a seizure, there is a small chance that the child may be injured by falling or may choke on food or saliva in the mouth.  Also, forcing the spoon into the mouth might knock off a tooth and then this choking the child.

There is no evidence that short febrile seizures cause brain damage.  Even when the seizures last a long time, most children recover completely. But seeking immediate medical attention when a child experiences seizure for its cause cannot be overemphasized.