Childhood Seizures: Types, Causes & First Aid Guide

What Are Seizures in Children?

Seizures in children are episodes of abnormal electrical activity in the brain that cause temporary changes in movement, behavior, sensation, or consciousness. They can range from brief staring spells to full-body convulsions with loss of consciousness and jerking movements. Most childhood seizures last 1-3 minutes and stop without treatment.

A seizure occurs when the brain's normal electrical activity becomes disrupted, causing nerve cells to fire abnormally. This abnormal electrical discharge can affect one part of the brain (focal seizure) or spread throughout the entire brain (generalized seizure). The symptoms a child experiences depend on which part of the brain is affected and how widely the abnormal activity spreads.

Seizures are more common in children than adults, particularly in the first few years of life when the brain is still developing. The developing brain has a lower threshold for seizure activity, which explains why febrile seizures occur almost exclusively in young children. As the brain matures, this susceptibility typically decreases, and many children outgrow their tendency to have seizures.

Understanding the nature of seizures is crucial for parents because it helps reduce the fear and anxiety that often accompanies witnessing these episodes. While seizures can look dramatic and frightening, the brain typically recovers completely once the abnormal electrical activity stops. The child may be confused, sleepy, or have a headache afterward, but these effects are temporary.

Why Do Children Have Seizures?

Children may have seizures for many different reasons, and in some cases, no specific cause can be identified. The most common causes include fever (febrile seizures), infections affecting the brain, head injuries, low blood sugar, and genetic conditions. Some children have an inherited tendency toward seizures, meaning the condition runs in their family.

In young children, the developing nervous system is more excitable than in adults, making it easier for the electrical signals in the brain to become disorganized. This is why febrile seizures occur almost exclusively in children under five years of age. The combination of high fever and an immature brain creates conditions where seizures are more likely to occur.

How Do Seizures Present in Children?

Childhood seizures can manifest in various ways: loss of consciousness, muscle stiffness followed by jerking movements, unresponsiveness with blank staring, facial twitching, drooling, and changes in skin color (pale or bluish). The child may lose bladder or bowel control. After the seizure, children are typically confused and very tired.

The presentation of a seizure depends largely on its type and the area of the brain affected. Parents often describe the experience as terrifying because the child may appear to stop breathing momentarily, turn blue or pale, and be completely unresponsive to their voice or touch. Understanding these symptoms can help parents respond appropriately rather than panicking.

During a generalized tonic-clonic seizure (the most recognized type), the child typically loses consciousness suddenly. The body first becomes rigid (the tonic phase), with the head often tilting backward and the limbs stiffening. This phase usually lasts 10-30 seconds. Following this, the clonic phase begins, characterized by rhythmic jerking movements of the arms and legs. The child may drool, foam at the mouth, or have shallow, irregular breathing.

Other seizure types may be less dramatic but equally concerning for parents. Absence seizures, for example, cause the child to stare blankly into space for several seconds, appearing to "zone out" completely. They may blink rapidly or make subtle mouth movements but won't respond when called. These episodes end abruptly, with the child resuming their previous activity as if nothing happened.

Common Signs During a Seizure

Recognizing the signs of a seizure is the first step in providing appropriate care. While symptoms vary widely between different seizure types and individual children, certain signs are commonly observed:

• Loss of consciousness or awareness: The child becomes completely unresponsive or has a "far-away" look
• Muscle stiffness: The body may become rigid, with arms and legs extended
• Rhythmic jerking movements: Often affecting the entire body or just certain limbs
• Changes in breathing: Breathing may become shallow, irregular, or appear to stop briefly
• Skin color changes: The face and lips may become pale, gray, or bluish
• Drooling or foaming: Excess saliva may accumulate in the mouth
• Loss of bladder or bowel control: This is common during generalized seizures
• Teeth clenching: The jaw may clamp shut tightly

What Happens After a Seizure?

After a seizure ends, children typically enter what's called the postictal state, a recovery period that can last from several minutes to hours. During this time, the child may be extremely sleepy and difficult to wake, confused about where they are or what happened, irritable or emotional, complain of headache, or have temporary weakness in their limbs. This recovery period is completely normal and should not cause additional concern.

What Are the Different Types of Seizures in Children?

The three most common types of seizures in children are febrile seizures (triggered by fever), breath-holding spells (triggered by strong emotions), and epileptic seizures (recurrent seizures due to brain electrical abnormalities). Each type has distinct characteristics, triggers, and treatment approaches.

Understanding the different types of seizures helps parents and caregivers recognize what their child is experiencing and respond appropriately. While all seizures involve abnormal brain activity, their causes, presentations, and long-term implications vary significantly. Accurate identification of seizure type is essential for proper management and for determining whether ongoing treatment is necessary.

Febrile Seizures

Febrile seizures are the most common type of seizure in young children, affecting approximately 2-5% of children between six months and five years of age. They occur when a child's body temperature rises rapidly, typically during the onset of an illness such as a common cold, ear infection, or viral illness. The seizure usually happens when the fever exceeds 38.5°C (101.3°F), particularly if the temperature rises quickly.

During a febrile seizure, the child typically loses consciousness, and their body becomes stiff before rhythmic jerking movements begin. The child's skin may become pale or slightly blue, and they may drool or foam at the mouth. Most febrile seizures last less than five minutes and resolve on their own without any intervention.

Simple febrile seizures, the most common type, are generalized (affecting the whole body), last less than 15 minutes, and don't recur within 24 hours. Complex febrile seizures last longer than 15 minutes, may affect only one side of the body, or recur within 24 hours. The distinction is important because complex febrile seizures may require more extensive medical evaluation.

Despite their frightening appearance, febrile seizures are generally harmless and don't cause brain damage or learning problems. About one-third of children who have a febrile seizure will have another one, usually within the next one to two years. The risk of developing epilepsy after simple febrile seizures is only slightly higher than in the general population.

Breath-Holding Spells

Breath-holding spells are not true seizures but are often confused with them because they can cause loss of consciousness and brief jerking movements. These episodes occur in about 5% of children, typically between six months and six years of age. They are triggered by strong emotions such as anger, frustration, fear, or pain.

In a typical breath-holding spell, the child cries intensely in response to an emotional trigger, then suddenly stops breathing and becomes silent. The child's face may turn blue (cyanotic breath-holding) or pale (pallid breath-holding). After a few seconds to a minute of not breathing, the child loses consciousness and may become limp or have brief stiffening or jerking movements.

While terrifying for parents to witness, breath-holding spells are not harmful to the child. The child cannot voluntarily hold their breath long enough to cause injury - the loss of consciousness triggers a reflex that restarts breathing. These episodes do not cause brain damage or developmental delays, and most children outgrow them by age six.

Epileptic Seizures

Epilepsy is a neurological condition characterized by recurrent, unprovoked seizures. Unlike febrile seizures (which are triggered by fever) or breath-holding spells (which are triggered by emotions), epileptic seizures occur due to an underlying tendency for the brain to generate abnormal electrical activity.

Epileptic seizures in children can take many forms. Generalized tonic-clonic seizures involve the entire body and cause loss of consciousness with stiffening and jerking. Absence seizures cause brief episodes of staring and unresponsiveness, often multiple times per day. Focal seizures begin in one area of the brain and may cause unusual sensations, movements in one part of the body, or altered awareness.

A special type of epileptic seizure in infants is infantile spasms, which typically appear between four and seven months of age. These present as brief, sudden flexion movements - the baby's head drops forward, arms flex, and knees pull up. The spasms often occur in clusters, particularly upon waking. Infantile spasms require urgent medical attention as early treatment can significantly improve outcomes.

What Should I Do When My Child Has a Seizure?

During a seizure: stay calm, time the seizure, ensure airways are clear, loosen tight clothing, place the child on their back during the seizure then in recovery position afterward, do NOT put anything in their mouth, do NOT restrain movements. Call emergency services if it's the first seizure, lasts more than 5 minutes, or the child doesn't recover normally.

Witnessing your child have a seizure is one of the most frightening experiences a parent can face. However, knowing the correct steps to take can help you protect your child and remain calm during the episode. The most important thing to remember is that most seizures end on their own within a few minutes and do not cause lasting harm.

Your immediate priority during a seizure should be ensuring your child's safety rather than trying to stop the seizure itself. Seizures cannot be stopped once they start, and attempting to do so can cause injury. Instead, focus on preventing injury and supporting your child through the episode.

Step-by-Step First Aid for Seizures

1. Stay calm and note the time: Check the clock or start a timer as soon as the seizure begins. Knowing the duration is critical information for medical professionals and helps determine whether emergency services are needed.
2. Ensure a safe environment: Gently move any objects that could cause injury away from your child. If possible, place something soft under their head, but don't move the child unless they're in immediate danger (such as near water or traffic).
3. Clear the airway: Make sure your child can breathe by ensuring nothing is blocking their mouth or nose. However, never put your fingers or any object in their mouth - contrary to popular belief, it's impossible to swallow your tongue during a seizure.
4. Loosen restrictive clothing: Gently loosen any clothing around the neck, chest, or waist that might make breathing more difficult.
5. Position appropriately: During the active seizure, you can place your child on their back on a flat surface. Once the seizure stops, gently roll them onto their side (recovery position) with their face slightly tilted down so saliva or vomit can drain.
6. Stay with your child: Remain by your child's side throughout the seizure and the recovery period afterward. Speak calmly and reassuringly, even if they appear unconscious.

When Should I Seek Medical Care for My Child's Seizure?

Seek emergency care immediately if: the seizure lasts more than 5 minutes, the child doesn't regain consciousness within 5 minutes after the seizure, it's the child's first seizure ever, the child has difficulty breathing, multiple seizures occur within 24 hours, or the child seems unwell afterward. Any first seizure should be evaluated by a healthcare provider.

While most childhood seizures are not emergencies and resolve without intervention, certain situations require immediate medical attention. Understanding when to call for help versus when to monitor at home can be challenging, but there are clear guidelines that can help parents make this important decision.

If your child has a known seizure disorder and has had seizures before that follow a predictable pattern, you may not need to seek medical care for every episode - follow the guidance your healthcare provider has given you. However, if anything about the seizure seems different from usual, or if your child doesn't recover normally, medical evaluation is warranted.

Call Emergency Services Immediately If:

• The seizure lasts more than 5 minutes
• The child doesn't regain consciousness within 5 minutes after the seizure stops
• This is the child's first seizure ever
• The child has difficulty breathing during or after the seizure
• The child appears injured from the seizure
• The seizure occurs in water
• Another seizure begins before the child has fully recovered
• The child has a known medical condition such as diabetes or heart disease

Contact Your Healthcare Provider Promptly If:

• The seizure is different from previous seizures (longer, more intense, or affecting different body parts)
• The child doesn't seem to be recovering normally
• Multiple seizures occur within the same day
• The child has been ill or had a recent head injury
• You have concerns or questions about the seizure

How Are Childhood Seizures Diagnosed?

Diagnosis involves a detailed history of what happened, physical examination, and often additional tests. An electroencephalogram (EEG) measures brain electrical activity. MRI scans may be done to look for structural abnormalities. Blood tests help identify infections or metabolic causes. The specific tests ordered depend on the seizure type and suspected cause.

Diagnosing the cause and type of a child's seizure involves gathering detailed information about what happened before, during, and after the episode. Since healthcare providers rarely witness the seizure itself, the description provided by parents or caregivers is crucial. If possible, recording a video of the episode on your phone can be extremely helpful for accurate diagnosis.

The diagnostic process typically begins with a thorough medical history and physical examination. Your healthcare provider will ask about the seizure's duration, what movements occurred, whether consciousness was lost, what the child was doing before the seizure, any recent illness or fever, and family history of seizures. They will also perform a neurological examination to assess brain function.

Common Diagnostic Tests

Depending on the clinical situation, your child may undergo one or more of the following tests:

Electroencephalogram (EEG): This is the most important test for evaluating seizures. Small electrodes are placed on the scalp to record the brain's electrical activity. The test is painless and non-invasive. An EEG can help identify abnormal brain wave patterns that might indicate a seizure disorder, help classify the type of seizure, and sometimes reveal the location in the brain where seizures originate.

Brain Imaging: Magnetic resonance imaging (MRI) provides detailed pictures of the brain's structure and can identify abnormalities that might cause seizures, such as malformations, tumors, or evidence of previous injury. MRI is generally preferred over CT scans for children because it provides more detail and doesn't use radiation.

Blood Tests: These can help identify infections, metabolic problems (such as low blood sugar or electrolyte imbalances), genetic conditions, or other medical issues that might cause or contribute to seizures.

How Are Seizures in Children Treated?

Treatment depends on seizure type and frequency. Febrile seizures often need no specific treatment beyond fever management. Epilepsy is treated with daily antiepileptic medications that prevent seizures in about 70% of children. Emergency medications like benzodiazepines can stop prolonged seizures. Some children may be candidates for special diets or surgery.

The treatment approach for childhood seizures varies widely depending on the type of seizure, how often they occur, their underlying cause, and their impact on the child's life. For many children with occasional, brief seizures, treatment focuses on safety measures and reassurance rather than medication.

The primary goals of seizure treatment are to prevent seizures when possible, minimize their impact on the child's development and quality of life, and manage any underlying conditions that might be causing the seizures. Treatment decisions are always individualized and should involve a careful discussion between parents and healthcare providers about the risks and benefits of different approaches.

Treatment for Febrile Seizures

Most children with febrile seizures do not require ongoing medication to prevent future seizures. The standard approach includes treating the underlying illness causing the fever, keeping the child comfortable during febrile illnesses, and teaching parents first aid for seizures. Fever-reducing medications like acetaminophen (paracetamol) or ibuprofen may be used for comfort but have not been proven to prevent febrile seizures.

Treatment for Epilepsy

Children diagnosed with epilepsy are typically treated with antiepileptic medications (AEDs). These medications don't cure epilepsy but can effectively prevent seizures in approximately 70% of children. The specific medication chosen depends on the type of seizures, the child's age, potential side effects, and other individual factors.

Common antiepileptic medications used in children include levetiracetam, valproic acid, carbamazepine, oxcarbazepine, and lamotrigine. Treatment usually starts with a single medication at a low dose, which is gradually increased until seizures are controlled or side effects become problematic. If the first medication doesn't work, another may be tried, or sometimes combinations of medications are used.

Emergency Treatment for Prolonged Seizures

Children who have a history of prolonged seizures may be prescribed emergency medications to stop seizures if they last longer than a specified time (usually 5 minutes). These are typically benzodiazepine medications such as diazepam (rectal gel) or midazolam (nasal spray or buccal solution) that parents or caregivers can administer at home or school. Training on when and how to use these medications is essential.

Other Treatment Options

For children whose seizures are not controlled by medication, other options may be considered. The ketogenic diet, a high-fat, low-carbohydrate diet, can be effective for some types of epilepsy. Vagus nerve stimulation involves implanting a device that sends electrical signals to the brain to reduce seizures. In some cases, surgery to remove the area of brain where seizures originate may be an option for children with focal epilepsy that doesn't respond to medication.

Can Seizures in Children Be Prevented?

Prevention depends on seizure type. Febrile seizures cannot be reliably prevented, even with fever-reducing medication. For epilepsy, taking prescribed medications consistently, getting adequate sleep, and avoiding known triggers helps prevent seizures. Breath-holding spells may be reduced by minimizing emotional triggers and staying calm during episodes.

Parents naturally want to know if they can prevent their child from having seizures. The answer depends largely on the type of seizure and its underlying cause. While complete prevention isn't always possible, there are steps that can reduce the frequency and severity of seizures in many children.

For children with epilepsy, the most important preventive measure is consistent adherence to prescribed antiepileptic medication. Missing doses or stopping medication without medical guidance is a common cause of breakthrough seizures. Other helpful measures include ensuring adequate sleep, maintaining regular meal times, managing stress, and avoiding any identified personal seizure triggers.

Can Febrile Seizures Be Prevented?

Despite parents' best efforts, febrile seizures often cannot be prevented. Research has shown that treating fever with antipyretics (fever-reducing medications) does not reliably prevent febrile seizures. This is because seizures often occur at the onset of fever, before parents even realize the child is sick. However, treating fever is still appropriate for the child's comfort.

In rare cases where a child has very frequent or prolonged febrile seizures, a healthcare provider might prescribe medication to be given at the first sign of illness to reduce seizure risk. This approach is not routine and is reserved for specific situations.

Managing Breath-Holding Spells

While breath-holding spells cannot be completely prevented, there are strategies that may help reduce their frequency. These include maintaining a calm household environment, avoiding situations known to trigger episodes, not giving in to demands during tantrums (as this may inadvertently reinforce the behavior), ensuring adequate sleep and regular meals, and checking for and treating iron deficiency, which has been linked to breath-holding spells.