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The most common cause of a seizure in a child under five years is febrile convulsion, the result of high temperature temporarily affecting the more immature parts of a child's brain. Most commonly, febrile convulsions occur in children 18 months to two years, and there may be a family history.
Although febrile convulsions occur in one in 20 young children, over time a child's brain will become increasingly less sensitive to high temperatures. Only one–two per cent of children who have febrile convulsions will subsequently be diagnosed with epilepsy.
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A seizure occurs when there is sudden overactivity of brain cells. Having a seizure doesn't necessarily mean a child has epilepsy – a diagnosis is only made when a child has had more than one seizure that is not triggered by fever (febrile convulsion) or by a new injury to the brain such as concussion, infection or other illness, and is confirmed on an electro-encephalogram (EEG).
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What to do when a child has a seizure
If a child in your care has a seizure try to stay calm. Most seizures – even if a child has epilepsy – settle in one–two minutes. The child can be nursed during the convulsion, but if there is much dribbling it is preferable to lie the child on a lounge or bed without a pillow. A towel under the head avoids saliva soaking through onto the lounge or bed.
During a seizure, a child will be non responsive and their eyes will roll back; their body will stiffen and then start rhythmically jerking. The child may stop breathing briefly – by holding their breath – but will spontaneously start to breathe again once the seizure settles. Since the child will not be able to swallow normally, saliva will build up in their mouth. As soon as possible during the seizure, or after it settles, turn the child onto their side so that the saliva can run out of the mouth rather than be breathed in with the first deep breath.
Contrary to common belief, a child is not able to swallow their tongue, but it is still important to lie children on their side so that the tongue falls forward rather than backwards over the throat. Also, sponging a child's body with cold or luke-warm water may actually cause a child's temperature to rise higher if they cry or shiver. It is preferable to remove extra clothing to help the child's body cool down. Do not put anything in the child's mouth until they are moving and swallowing normally.
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If the seizure lasts more than five minutes an ambulance should be called, as once a seizure has continued for over 30 minutes it is harder to control, and the risk of permanent brain damage gradually increases after that.
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Diagnosing epilepsy
Once a seizure has ceased, the child needs to be checked by a doctor or at a hospital, depending on accessibility, to work out what has caused the increase in temperature. The most common cause is ear infection which is hard to pick up without a doctor actually looking at a child's ear drum.
The good news is that most children who have febrile convulsions will grow out of them without any long-term effects. Children who are diagnosed with epilepsy, and don't have any underlying brain condition, also have a strong chance of growing out of epilepsy, or at least having it well-controlled with regular medication.
Margaret Kyrkou
Senior Medical Practitioner
Children, Youth and Women's Health Service
Every Child magazine – vol. 14 no. 2, 2008, p. 10
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