A seizure represents a sudden, temporary burst of uncontrolled electrical activity within the brain, causing a change in a person’s movement, behavior, or level of awareness. While the sight of a child having a seizure can be distressing for caregivers, these neurological events are relatively common in childhood. Many first-time seizures in children are provoked by a specific trigger and are not indicative of a long-term condition like epilepsy. Understanding the different types of seizures that affect children is important for knowing how to respond and when to seek medical help.
The Most Common Seizure: Febrile Seizures
Febrile seizures are the most frequent type of seizure in children, triggered by a fever, typically 100.4°F (38°C) or higher. These events occur in approximately 2% to 5% of all children, making them the most common convulsive event in the pediatric population. They usually occur between the ages of six months and five years, with the highest incidence seen between 12 and 18 months of age. They are considered benign because they are not caused by a brain infection or injury and are typically outgrown by the time a child reaches school age.
Febrile seizures are commonly categorized into two subtypes: simple and complex. A simple febrile seizure is a generalized event, involving both sides of the brain, and lasts for less than 15 minutes. It occurs only once within a 24-hour period during a single illness. These simple events account for the majority, around 70% to 75%, of all febrile seizures.
A complex febrile seizure has one or more atypical features. These include the seizure lasting longer than 15 minutes or having a focal component, where movements are limited to one side of the body. They are also classified as complex if they recur within the same 24-hour period. Despite the presentation, the long-term outlook for children who experience either simple or complex febrile seizures remains favorable.
Febrile seizures do not cause brain damage, intellectual disability, or long-term negative effects on development. The risk of a child later developing epilepsy, defined as recurrent, unprovoked seizures, is only slightly higher than that of the general population. Recurrence is common, with about one-third of children having another febrile seizure, but this risk significantly decreases after age three. After a febrile seizure, the focus shifts to identifying and treating the source of the fever.
Other Frequent Types of Childhood Seizures
When seizures occur without a fever or outside the typical age range for febrile events, they may be classified as unprovoked, potentially indicating an underlying epilepsy syndrome. Among the most common non-febrile seizures in children are absence seizures, formerly known as petit mal seizures. These episodes cause an abrupt, brief loss of awareness, often appearing as a simple staring spell that lasts only three to 15 seconds.
Children experiencing an absence seizure suddenly stop their current activity and stare blankly, often not responding to voices or touch. Subtle automatisms, such as eyelid fluttering or lip smacking, may accompany the staring. Because these seizures are short and subtle, they can happen dozens of times a day and are frequently mistaken for daydreaming or inattention. Childhood absence epilepsy, characterized by these seizures, typically begins between the ages of four and eight.
Generalized tonic-clonic seizures, previously called grand mal seizures, are another common type that can occur outside of a fever-related context. This type of seizure involves two distinct phases: the tonic phase, where the body, arms, and legs stiffen, and the clonic phase, which involves rhythmic jerking and shaking movements. These seizures result in a complete loss of consciousness and can last between one and three minutes.
Focal seizures, also known as partial seizures, originate in a specific area of one side of the brain. Symptoms vary widely depending on the region affected. They may manifest as motor symptoms, such as uncontrollable twitching or jerking of a single limb. Non-motor symptoms can include a sudden feeling of fear, an odd smell, or repetitive behaviors like walking aimlessly or picking at clothes. If a focal seizure spreads to involve both sides of the brain, it becomes a focal-to-bilateral tonic-clonic seizure, resulting in full-body convulsions.
Responding to a Seizure and Seeking Medical Guidance
Witnessing a child have any type of seizure requires a calm, immediate response focused on safety. The primary action is to protect the child from injury by gently easing them to the floor and clearing the area of sharp objects. Turn the child gently onto their side to keep the airway clear and prevent choking. Cushion the child’s head with something soft, like a jacket, and loosen any tight clothing around the neck.
Caregivers must not restrain the child or put anything into their mouth, as this can cause injury to the child or the responder. Timing the event from start to finish is important information for medical providers. Most seizures, including the simple febrile type, resolve naturally within a few minutes.
Emergency medical services should be called immediately if the seizure lasts longer than five minutes. Immediate help is also necessary if the child has trouble breathing or appears bluish, is injured during the event, or does not regain consciousness shortly after the seizure stops. Any time a child experiences their first-ever seizure, even a brief one, medical evaluation in an emergency setting is recommended to determine the cause.
Following any seizure event, especially the first one, a consultation with a pediatrician or a pediatric neurologist is warranted. The doctor will conduct a thorough evaluation to identify any underlying causes and provide guidance. This consultation allows caregivers to gain a proper diagnosis, understand the specific type of seizure that occurred, and receive an action plan for potential future events.