FEBRILE

SEIZURES
By :

Angga Wahyu Mahardika

DEFINITION
Febrile seizures are the most common type of
seizure seen during childhood (American
Academy of Pediatrics, 2008; Johnston, 2007)
They usually affect children who are younger
than 5 years of age, with the peak incidence
occurring in children between 14 and 18 months
old.
Febrile Seizures (FS) occurs as a result of
infection outside the CNS or to high
environmental temperature in a child who is
normal neurologically.

Febrile seizures are seizures that occur in young children who

have fever but no evidence of intracranial infection or acute
neurologic illness.
Simple febrile seizures are generalized tonic-clonic convulsions
that last less than 15 minutes and do not recur within 24 hours.
Complex febrile seizures are less common and are focal or
prolonged beyond 15 minutes or recur within 24 hours.
Febrile seizures occur in children between 3 months and 5 years
of age; the median age of occurrence is 18 to 22 months.
The EEG is normal.
Approximately 2% to 5% of children will experience a febrile
convulsion; boys are more susceptible than girls.
Familial clustering of febrile seizures occurs and mutations of
the SCN1A gene have been found in some families.

Febrile seizures are more commonly seen in boys

and there is an increased risk for children who
have a family history of febrile seizures.
Febrile seizures are associated with a fever,
usually related to a viral illness.
However, febrile seizures may be a sign of a
dangerous underlying infection, such as
meningitis or sepsis.
Though rare, complications associated with
febrile seizures include status epilepticus, motor
coordination deficits, intellectual disability, and
behavioral problems.

ETIOLOGY

Until now, the etiology of febrile seizures is not

known with cerainty. Fever is often caused by:
Infection
Otitis

media
Pneumonia
Gastroenteritis
Urinary track infection

Seizures are not always arise at high

temperatures. Sometimes that is not so high can
cause seizures
Other causes of febrile seizures is the use of
certain drugs such as :

Diphenhydramine
Tricyclic

antidepressants
Amphetamines
Cocaine
Dehydration resulting in disruption of waterelectrolyte balance

RISK FACTOR
1.

Age

3% of children under 5 years old have experienced

febrile seizures
The highest incidence (age of 2 years & decreased
after 4 years), (rarely occurs in the age of 6
months / more than 5 years)
The first attack usually occurs within the first 2
years and then declines with age

2.

Gender

3.

Ratio (Boys : Girls) = 2 : 1

This may be caused by cerebral maturation faster
in women than in men

Body temperature

High body temperature at the time of the attack

raised seizure threshold value. Different between
38,3 C 41,4 C.

4.

Heredity

5.

25% - 50% of children who have febrile seizures

have family members (parents, siblings) who have
experienced febrile seizures at least once.

Other factors include :

A history of febrile seizures parents or siblings

Delayed development
Problems in the newborn period
Children in special care
Low sodium level

SYMPTOMS
A febrile seizure may be as mild as the childs
eyes rolling or limbs stiffening. A simple febrile
seizure stops by itself within a few seconds to 10
minutes. It is often followed by a brief period of
drowsiness or confusion
Febrile seizures may begin with the sudden
tightening (contraction) of muscles on both sides
of a childs body

The child may cry or moan

The muscles tightening may last for several seconds, or
longer
The child will fall, if standing, and may pass urine
The child may vomit or bite the tongue
Sometimes children do not breathe, and may begin to turn
blue
The childs body may then begin to jerk rhythmically. The
child will not respond to the parents voice

*) A seizure that last longer than 15 minutes, is in just one

part of the body, or occurs again during the same illness is not
a normal febrile seizure.

TREATMENT
During the seizures, leave your child on the floor.
You may want to slide a blanket under the child if the floor is
hard
Move the child only if in a dangerous location
Remove objects that may cause injury
Loosen any tight clothing, especially around neck. If possible,
open or remove clothes from the waist up
If the child vomits, or if saliva and mucus build up in the
mouth, turn the child to the side or on the stomach. This is also
important if it looks like the tongue is getting in way of
breathing
Do NOT try to force anything into the childs mouth to prevent
bitting the tongue, as this increases the risk of injury. Do NOT
try to restrain your child or try to stop the seizure movements.

CONT....
Focus your attention on bringing the fever down:
Insert an acetaminophen suppository (if you have some) into
the childs rectum
Do NOT try to give anything by mouth
Apply cool washcloths to the forehead and neck. Sponge the rest
of the body with lukewarm (not cold) water. Cold water or
alcohol may make the fever worse
After the seizures is over and your child is awake, give the
normal dose of ibuprofen or acetaminophen.
After the seizure, the most important step is to identify the cause
of the fever.
Meningitis causes less than 0,1% of febrile seizures. It should
always be considered, especially in children less than 1 year old,
or those who still look ill when fever comes down.

THERAPEUTIC MANAGEMENT
Includes determination and treatment of the cause
of the fever and interventions to control the fever.
The American Academy of Pediatrics does not
recommend long-term or intermittent
anticonvulsant therapy for the child who has
suffered one or more simple febrile seizures
(American Academy of Pediatrics, 2008).
Rectal diazepam has been shown to be safe and
effective in terminating febrile seizures and may
be used in children at high risk for febrile seizures
or in children whose parents are extremely
anxious.

NURSING ASSESSMENT

A febrile seizure is usually associated with a

rapid rise in core temperature to 39C (102.2F)
or higher.

NURSING DIAGNOSIS &

INTERVENTIONS
1.

Hypertermia

Goal : Normal body temperature

Outcomes : temperature 36,5 37,5 C and the
clients are free from fever
Interventions :

Observation of vital sign every 4 hours

Provide a description of the family regarding the
provision compress
Give light clothing that can absorb sweat
Encourage clients to drink
Engage in collaboration with the medical team for
giving antipyretics and antibiotics

2.

Risk for ineffective airway clearence

Goal : maintain effective breathing pattern with a

clean airway and prevented from aspiration
Outcomes : normal respiration : 15-30 x / mins and
no muscle retraction
Intervention :

Place the patient in a comfortable position (semi-fowler)

Loosen clothing especially on the neck, chest and
abdomen
Give spatel in mouth
Suction if necessary
Give O2 in accordance with the requirement

3.

Knowledge deficit

Goal : verbally client can reveal that stimulation may

increase seizures
Outcomes : clients can take medication on a regular
basis
Intervention :

Assess pathology and prognosis of the condition of the

client
Assess treatment that has been done
Provide nutritious food
Discuss the effects of drugs
Explain how to prevent infection
Immediately lower the heat in the event of a seizures
Teach the family to give anti-seizure drugs and antipyretics
in accordance with the rules of the medical team

4.

Risk for injury / trauma

Goal : verbally clients can find out the factors that

allow the trauma
Outcomes : clients are free from trauma when
seizure occurs
Intervention :

Explain the factors predisposing to seizures

Keep clients from trauma by providing a safety on the
side of the bed
Keep the client in the event of an aura
Stay with the client during the phase of seizures

5.

Impaired self-concept (low self esteem)

Goal : verbally clients do not experience a misinterpretation and low self-esteem doesnt happen
Outcomes : clients and families can know correctly
about prognosis, treatment regimen and treatmen
of the seizures
Intervention :

Provide a description of teh disease, treatment, and

prevention method
Explain how to avoid the risk factors
Answer questions and accommodate all clients and
families

THANK YOU