Recognizing the signs of a seizure in a baby is important, as they can appear differently from those in older children or adults. Understanding these distinctions helps in providing appropriate care and seeking timely medical attention.
How Baby Seizures Appear
Seizures in babies result from unusual bursts of electrical activity among brain cells. These can manifest in various ways, often subtly, making them difficult to identify.
Focal seizures originate in one part of the brain and can lead to localized, subtle movements. These might include repetitive eye movements like rolling, blinking, or staring. Oral movements such as lip smacking, sucking, chewing, or tongue protrusion can also occur. Sometimes, a baby may show unusual bicycling or pedaling movements of the legs, or thrashing. Changes in skin color or brief pauses in breathing, known as apnea, can also be present.
Generalized seizures involve widespread electrical activity affecting both sides of the brain simultaneously. Infantile spasms typically occur between 2 and 12 months of age, peaking around 4 to 8 months. These spasms involve sudden, brief stiffening of the body, often with the head, trunk, and limbs bending forward in a “jackknife” position, or sometimes arching backward. Each spasm lasts one to two seconds but often happens in clusters, occurring every 5-10 seconds, typically after waking from sleep.
Myoclonic seizures present as sudden, brief jerks of a muscle or group of muscles, often affecting the head and arms. These jerks can occur as solitary episodes or in clusters.
Tonic seizures involve a sustained stiffening or tightening of muscles in one area or the entire body. During a tonic seizure, a baby might bend their arms and legs into awkward positions, or their head and eyes might turn to one side.
Clonic seizures are characterized by repeated, rhythmic jerking movements. These can involve the face, tongue, arms, or legs. While focal clonic seizures affect one side of the body, generalized clonic seizures involve both sides.
Atonic seizures, sometimes called drop attacks, cause a sudden loss of muscle tone, leading the baby to go limp and unresponsive.
Normal Baby Movements Versus Seizures
Distinguishing between normal infant movements and seizure activity is important. Seizures are generally not suppressible, meaning they continue despite attempts to stop them. Normal movements can often be interrupted or stopped by gently holding the limb. A baby having a seizure may stare blankly or be unresponsive.
The startle reflex, also known as the Moro reflex, is a normal part of infant development. This reflex occurs when a baby is startled by a loud sound or sudden movement, causing them to throw their head back, stiffen, and extend their arms, then bring them back in. This reflex typically disappears between 3 and 6 months of age.
Infantile spasms can sometimes resemble the Moro reflex but usually begin later, between 3 months and a year. They occur in clusters rather than as single, triggered events.
Tremors or jitteriness in infants are often related to factors like temperature changes, hunger, or excitement. These movements typically cease when the affected limb is gently held.
Benign sleep myoclonus involves brief jerks that occur only during sleep and stop when the baby wakes up.
Normal feeding movements, such as sucking, rooting, and lip smacking, are distinct from seizure activity because they are purposeful and responsive to feeding cues.
Shivers or shudders are brief, non-rhythmic movements usually associated with cold.
Associated symptoms during a seizure, such as eye deviation, changes in skin color, or post-event drowsiness, also help distinguish them from benign movements. Observing the baby’s state before, during, and after the event provides valuable information for medical professionals.
Immediate Steps During a Seizure
If a baby is suspected of having a seizure, ensure the baby’s safety by preventing injuries. Gently place the baby on a soft surface, such as the floor or a bed, away from any hard or sharp objects.
Carefully turn the baby onto their side. This position helps prevent choking if the baby vomits or has excessive saliva.
Loosen any tight clothing around the baby’s neck to ensure clear breathing.
Do not put anything into the baby’s mouth, including fingers or objects, as this can cause injury to both the baby and the caregiver.
Do not attempt to restrain the baby’s movements, as this will not stop the seizure and could lead to injury. Allow the movements to continue while protecting the baby from harm.
Time the duration of the seizure from its beginning to its end. This information is important for medical professionals.
If possible and safe, record the event on a phone. A video recording can provide valuable visual information to doctors, aiding in diagnosis and treatment.
When to Contact a Doctor
Seek immediate emergency medical help in several situations. Call 911 or emergency services if the seizure lasts longer than 5 minutes, or if the baby stops breathing or turns blue during or after the seizure.
Immediate help is also warranted if the baby sustains an injury during the seizure, such as from a fall, or if this is the baby’s first suspected seizure.
Seek immediate help if the baby does not regain consciousness or act normally after the seizure, or if multiple seizures occur in a short period without full recovery in between.
In non-emergency situations, contact a pediatrician or doctor promptly.
If a suspected seizure occurs and the baby recovers quickly, appearing normal afterward, but the event is concerning, a medical evaluation is still recommended.
If the baby has a known seizure disorder but experiences a seizure that is different from their usual pattern, medical advice should be sought.
Following any suspected seizure, keep a detailed record of the event. Note the date, time, and duration of the seizure, a description of the movements observed, and the baby’s state before and after the event. This information assists healthcare providers in understanding the nature of the event, investigating potential causes, and determining an appropriate treatment plan.