A seizure represents a sudden, uncontrolled electrical disturbance within the brain that temporarily alters a child’s behavior, movements, or level of consciousness. This abnormal activity disrupts the brain’s normal communication pathways, leading to a variety of physical and sensory manifestations. For parents and caregivers, understanding these signs is paramount for prompt recognition and appropriate action. The clinical presentation of a seizure is highly varied, depending on where the electrical storm begins and how far it spreads throughout the brain.
Recognizing Signs of Generalized Seizures
Generalized seizures originate simultaneously in both hemispheres of the brain, leading to signs that affect the entire body and often involve a loss of awareness. The most recognizable form is the tonic-clonic seizure, which presents with two distinct phases. The initial tonic phase involves a sudden stiffening of the muscles, which may cause the child to cry out or groan as air is forced past the vocal cords. During this phase, the child loses consciousness, and the muscles of the chest may stiffen, causing temporary difficulty in breathing, which can result in a bluish tint to the skin.
The tonic phase transitions into the clonic phase, characterized by rhythmic jerking movements of the arms and legs. During this convulsive period, the child’s teeth may clench, and there is a possibility of drooling, foaming at the mouth, or loss of bladder or bowel control. These jerking movements gradually slow down before stopping completely, typically after one to three minutes. Immediately after the movement ceases, the child remains unresponsive and may begin the recovery period.
Another form of generalized seizure is the absence seizure, which is much less dramatic and can be easily mistaken for daydreaming or inattention. These events are characterized by a brief lapse in awareness where the child abruptly stops all activity and stares blankly into space. The seizure is typically very short, lasting only three to seventeen seconds, and ends just as suddenly as it began. Subtle physical signs may accompany the staring, such as rapid eye blinking, a slight fluttering of the eyelids, or minor lip smacking.
Atonic seizures, often called “drop attacks,” are a third type of generalized seizure that causes a sudden, complete loss of muscle tone. If the child is standing, the episode results in an immediate, limp collapse to the floor. If sitting, the child’s head may suddenly droop forward, or they may simply go limp. These seizures are very brief, usually lasting less than 15 seconds, and consciousness may be maintained or only briefly lost.
Recognizing Signs of Focal Seizures
Focal Aware Seizures
Focal seizures begin in a limited area of one side of the brain, which means their manifestations are often localized and more subtle than generalized events. Focal aware seizures occur when the child remains fully conscious and aware of their surroundings during the event. The signs are determined by the brain region involved, and they can include localized motor activity such as involuntary twitching or jerking of a single limb, one side of the face, or a finger.
Sensory changes are also common with focal aware seizures, where the child may experience tingling, numbness, or a strange prickling sensation in one part of the body. Abnormal perceptions, sometimes referred to as an aura, can occur, involving the sudden experience of a strange odor or taste, seeing flashing lights, or hearing unusual sounds. Furthermore, children may report cognitive or emotional changes, such as a sudden, intense feeling of fear, anxiety, or the sensation of déjà vu.
Focal Impaired Awareness Seizures
Focal impaired awareness seizures involve an alteration or impairment of consciousness, meaning the child is not aware of what is happening or cannot respond normally. These seizures often manifest through automatisms, which are purposeless, repetitive behaviors. Observable signs include chewing or lip-smacking, fumbling with clothing, picking at the air, or wandering aimlessly.
A child experiencing an impaired awareness seizure may have a blank stare and be unable to speak or follow simple instructions. Though the eyes are open, the child is essentially unresponsive to external stimuli and will usually not remember the event afterward. These events can last longer than aware seizures, typically between one to two minutes, and the behaviors can sometimes be mistaken for misbehavior or an altered mental state not related to a seizure.
Managing the Post-Seizure Recovery Period
The period immediately following the active seizure is known as the post-ictal state, representing the brain’s recovery phase after the intense electrical activity. A child who has had a generalized seizure will often be confused, disoriented, and extremely fatigued. They may fall into a deep sleep for a period, which is a normal part of the recovery process, and may wake up with a headache or generalized muscle soreness.
A temporary weakness that affects one side of the body, known as Todd’s paralysis, can occur after a focal seizure, especially one involving localized motor activity. This weakness can affect an arm, a leg, or even speech. It is a temporary neurological symptom that resolves on its own, typically within 30 minutes to 36 hours.
During this recovery phase, the immediate priority is comfort and safety, as the child is vulnerable and often unaware of their surroundings. Once the shaking or movement has completely stopped, the child should be gently rolled onto their side into the recovery position. This simple action helps keep the airway open and allows any fluid or vomit to drain, preventing aspiration. Caregivers should remain with the child, offering quiet reassurance and comfort, and avoid giving the child anything to eat or drink until they are fully awake and alert.
Immediate Actions and Emergency Criteria
Safety During a Convulsive Seizure
The proper response to a seizure begins with ensuring the child’s immediate physical safety and timing the event. If the child is having a convulsive seizure, gently move them to the floor or ground, clear the area of sharp or hard objects, and place something soft under their head. It is important to remember not to restrain the child’s movements or place anything inside their mouth.
When to Call Emergency Services
An immediate call for emergency services is required if the seizure lasts longer than five minutes. This time limit is the threshold for a prolonged seizure requiring medical intervention. An emergency call is also warranted if this is the child’s first-ever seizure, as a medical evaluation is required to determine the cause and appropriate management.
Other specific circumstances also mandate an immediate emergency response:
- The child has trouble breathing or their lips and face turn a deep bluish color after the seizure stops.
- The child sustains a significant injury, such as a head trauma from a fall.
- The seizure occurred while the child was in water.
- The child does not regain consciousness or return to their normal level of awareness quickly after the movements subside.