Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Febrile Seizures in Children

Category: Child Care

Febrile seizures are extremely frightening for any parent. They typically occur in children between 6 months and 5 1/2 years of age. They are usually associated with a rapid increase in temperature from normal to higher than 101. Occasionally, an extremely high fever such as 106 will be associated with the seizure. Typically, though, the fever is in the 102-104 range and the seizure occurs while the fever is rising. Children who have febrile seizures seem to be prone to them and frequently have a positive family history.

There are several factors which a pediatrician looks for in febrile seizures to determine if it is truly a "typical" febrile seizure and not epilepsy triggered by a fever. Also, certain factors will guide the pediatrician and/or neurologist in deciding whether or not to put the patient on Phenobarbital.

In the past, the major guidelines for placing a patient on Phenobarbital was a child who's age did not fit the 6 month to 5 1/2 year category at the time they had the febrile seizure.

Second, any abnormal neurologic developments such as cerebral palsy syndrome, mental retardation, or small head size. Third, a seizure which lasted longer than 15 minutes, had focal signs rather than being generalized, or had any persistent neurologic abnormalities after the seizure.

Fourth, a positive family history of febrile seizures. Fifth, more than one febrile seizure within 24 hours. And, sixth, if the seizure occurred under 12 months of age and particularly under 6 months of age.

The National Institute of Health sponsored a consensus developmental conference in the 70's and 80's to look at these factors and see if they are true precedents predicting recurrent febrile seizures and thus warranting the need to take Phenobarbital. Their conclusions, after compiling 14 different studies at different centers between 1972 and 1987, was that a history of febrile seizures in the family (a parent or close relative who had febrile seizures) and a child's age (having a seizure before the age of 1 or after the age of 5-1/2 ) were the two greatest risks for recurrence of febrile seizures. The other factors were not considered that correlative.

These new guidelines will perhaps change the prescription practices of pediatricians and neurologists and we may be following many more kids who have febrile seizures in the future without placing them on Phenobarbital.