Febrile cramps with fever? Keep a cool head! Lowering your body temperature will help...

When do febrile convulsions occur?

Febrile convulsions are exclusively a matter of children. They do not occur in adults.

The name already implies that febrile convulsions come with fever. Their occurrence is typical when the temperature rises, which is why they are also referred to as initiation convulsions.

Febris (Latin) = fever = body temperature above 38 °C.
Fevers above 39 °C are risky.
In some predisposed children, they may occur at a lower temperature, above 38 °C.

They can affect children from 6 months to 5 years,
sometimes occur up to 7 years.
Febrile convulsions occur in about 5-9% of otherwise healthy children.

The susceptibility to febrile convulsions is inherited. Scientists have even located the genes responsible for this inheritance. They are located on chromosomes 8 and 19.

Therefore, if febrile convulsions occurred in one parent during childhood or in a sibling, there is up to a 50% risk that the child of these parents will also have febrile convulsions during high fever.

Epilepsy is a neurological disease that also manifests itself in tonic-clonic convulsions. If a sibling or parent of a child has epilepsy, the risk of the child responding to fever with febrile convulsions increases to 10%.

How to recognise febrile convulsions?

Febrile convulsions are tonic-clonic in nature. This means that they alternate between spasmodic stiffening of the limbs and twitching with relaxation of the muscles. Based on the nature of the convulsions, they are divided into uncomplicated and complicated convulsions. Based on this division, the treatment of the condition also differs.

Uncomplicated febrile convulsions:

onset between the 6th month and 5th year of life of the child
short spasms, usually up to 3 minutes, no longer than 10 to 15 minutes
seizure does not recur
the seizure has no neurological sequelae

Complicated febrile convulsions:

Occurrence in an infant younger than 6 months or in a child older than 5 years
seizure lasts longer than 10 to 15 minutes
recurs within 24 hours
the convulsions were localised, e.g. only on one half of the body
the seizure was followed by paralysis of the limbs, nausea, headache with vomiting, 'ragged' or stiff muscles, etc.
positive family history, e.g. epilepsy in the nearest relative (parent, sibling)
presence of developmental defects from birth, complicated birth, e.g. asphyxia or cerebral haemorrhage, mental retardation, head injury, suspected neuroinfection

We often wonder whether they can also occur in adults...
Febrile convulsions occur only in childhood.
However...
Febrile seizures can occur at temperatures above 40°C in adults.

Febrile convulsions are distinct from febrile collapse. In febrile collapse, there is sudden weakness of the limbs and tremors throughout the body. This condition occurs at high temperatures above 40°C.

In some cases, febrile convulsions and chills may also be confused.

How to help the child at home without medical help?

The most important point in caring for a sick child is to prevent febrile convulsions by not allowing the temperature to rise above 39 °C.

It is important to know that febrile convulsions come with a rise in temperature. Therefore, it is necessary to regularly check the temperature of the child and record the dynamics of the rise.

If it starts to rise, it is best to give drugs from the group of antipyretics, such as paracetamol or ibuprofen.

Adjust the dosage to the age and weight of the child. Follow the instructions in the package leaflet, do not administer higher doses and do not repeat the administration at shorter intervals.

We try to lower the temperature slowly. We do not put the child in cold water or shower him with cold water. After a sharp drop in temperature, there is another sharp rise, which is the most risky for the development of febrile convulsions.

Wraps made of a towel soaked in lukewarm water are suitable. This wet towel should be covered and another dry towel placed on top.

Leave the child in the wrap for a few minutes. Then uncover it and let the heat radiate freely into the area. The room should be ventilated but not cold.

Interesting fact: The wrap will effectively help reduce fever. Do you know how to make it properly?

Let the short-term cramps subside.

Most of them will subside within 2-3 minutes. Do not try to hold back the convulsions by hugging the baby tightly and avoid jerking. The convulsions take place under strong pressure and by holding the limbs you could hurt the baby.

Simply place the baby in a stable position on its side. Protect the baby's head so that it does not bang against the floor or furniture.

Do not try to pull out the baby's tongue or put anything in the baby's mouth. If the baby vomits, clean the baby's mouth so that there is no vomit to inhale.

Do not give any medicine to control the temperature during febrile convulsions. Give suppositories rather than tablets after the convulsions have stopped. This will prevent the risk of aspiration if the child starts convulsing again.

Read also: Taking blood pressure, pulse or body temperature at home. How to find out the readings?

When to call for help?

Febrile convulsions that last longer than 3 minutes require medical attention.

If the convulsions do not stop within 5 minutes of the first suppository, another suppository is given.

Convulsions that do not subside after two suppositories of diazepam require transfer to hospital. In hospital, diazepam will be given intravenously and the child's condition will be thoroughly diagnosed during hospitalisation.

The prophylactic administration of diazepam to children as a prevention of febrile convulsions is not recommended. Diazepam, like any drug, has many side effects.

If a child has regular febrile convulsions, one suppository of diazepam at 38 °C measured at the rectum may be given as a prophylactic measure to prevent recurrence of febrile convulsions.

However, this prophylaxis is always instigated by a physician.

If the child turns blue, this is a sign of suffocation. Immediately start mouth-to-mouth artificial respiration, cardiac massage and call an ambulance. However, such situations are very rare in febrile convulsions.

What tests will the child undergo during hospitalization?

After taking the child to the hospital, the diagnosis of complicated febrile convulsions begins.

This will first involve distinguishing whether the convulsions were caused by a temperature output or whether they may be a symptom of a neurological disease, such as an infection of the central nervous system.

A lumbar puncture is performed when meningitis is suspected and for convulsions in children younger than 12 months.

EEG (electroencephalography) is not recommended in seizures. The recording would be distorted and inconclusive. Also, EEG is not necessary in the first two weeks after a seizure.

In this time interval, about ⅓ of children have transient pathological waves. These results could be considered false positives even in a completely healthy child.

If parents require it and are concerned about more serious neurological disease, the EEG can be examined no earlier than 2 weeks after the seizure.

Of the imaging examinations, we prefer to perform a brain MRI on the child. Although CT scans are more accessible and faster, the child is exposed to radiation and the CT findings do not provide as detailed a picture of the brain tissue as an MRI.

Imaging studies are particularly warranted if the seizure occurred in children with a known neurological birth defect, with a previous brain disorder, in mentally retarded children, and if the seizures were localized to one limb or side of the body.

In the case of seizures in an infant, a congenital brain defect or cerebral haemorrhage is suspected. The diagnosis is confirmed by brain MRI. In the case of an undetected fontanelle, the brain can also be examined by ultrasonography (USG).

Differentially diagnosed, the child is also examined for the presence of inborn errors of metabolism. In many metabolic diseases, a dry drop of blood is sufficient to confirm the diagnosis, in some, a comprehensive genetic examination is necessary.

Will the cramps recur at every temperature?

If the cramps are uncomplicated, simple and last less than 3 minutes, their prognosis is excellent and they do not leave a permanent deficit.

The recurrence of febrile convulsions depends on the age at which they first appeared. If a child had febrile convulsions before 1 year of age, there is up to a 50% chance that they will recur at the next fever. Convulsions that appeared after 3 years of age have a 20% risk of recurrence.

If complicated convulsions occur in childhood, the risk of developing epilepsy later in life increases to 9%. Children who have had uncomplicated febrile convulsions have only a 1% risk of developing epilepsy.