Febrile seizures are common neurological events that occur in young children, usually between the ages of 6 months and 5 years, in response to a sudden spike in body temperature. These seizures are generally benign and typically last for a brief period, but they can be distressing for parents and caregivers.
While most febrile seizures do not cause long-term harm, understanding their causes, risk factors, management, and when to seek medical attention is essential for parents and healthcare providers. This article aims to serve as a comprehensive nursing guide to febrile seizures, exploring their clinical features, potential triggers, appropriate home care, and nursing interventions.
Table of Contents
- What is Febrile Seizure?
- Types
- Pathophysiology
- Statistics and Incidences
- Clinical Manifestations
- Assessment and Diagnostic Findings
- Medical Management
- Nursing Management
What is Febrile Seizure?
Pediatric febrile seizures, which represent the most common childhood seizure disorder, exist only in association with an elevated temperature.
- Febrile seizures are seizures or convulsions that occur in young children and are triggered by fever.
- Young children between the ages of about 6 months to 5 years old are the most likely to experience febrile seizures; this risk peaks during the second year of life.
- Evidence suggests, however, that they have little connection with cognitive function, so the prognosis for a normal neurologic function is excellent in children with febrile seizures.
Types
Epidemiologic studies have led to the division of febrile seizures into 3 groups, as follows:
- Simple febrile seizure. The setting is fever in a child aged 6 months to 5 years; the single seizure is generalized and lasts less than 15 minutes; the child is otherwise neurologically healthy and without neurologic abnormality by examination or by developmental history; fever (and seizure) is not caused by meningitis, encephalitis, or any other illness affecting the brain; the seizure is described as either a generalized clonic or a generalized tonic-clonic seizure.
- Complex, febrile seizure. In complex, febrile seizures, age, neurologic status before the illness, and fever are the same as for simple febrile seizures; this seizure is either focal or prolonged (ie, >15 min), or multiple seizures occur in close succession.
- Symptomatic, febrile seizure. In symptomatic febrile seizure, age and fever are the same as for simple febrile seizure and the child has a preexisting neurologic abnormality or acute illness.
Pathophysiology
The pathophysiology remains unknown, but there are theories surrounding its cause.
- This is a unique form of epilepsy that occurs in early childhood and only in association with an elevation of temperature.
- The underlying pathophysiology is unknown, but genetic predisposition clearly contributes to the occurrence of this disorder.
- The rate of body temperature rise as a cause is a frequently held theory, but this is unsupported by more recent laboratory and clinical studies.
- A specific neurotropism or CNS-invasive property of certain viruses (e.g., human herpesvirus-6 [HHV-6], influenza A), and bacterial neurotoxin (Shigella dysenteriae) has been implicated, but the evidence is inconclusive.
Statistics and Incidences
Febrile seizures are occurring all over the world in children of all ages.
- Febrile seizures occur in 2-5% of children aged 6 months to 5 years in industrialized countries.
- Among children with febrile seizures, about 70-75% have only simple febrile seizures, another 20-25% have complex febrile seizures, and about 5% have symptomatic febrile seizures.
- Children with a previous simple febrile seizure are at increased risk of recurrent febrile seizures; this occurs in approximately one-third of cases.
- Children younger than 12 months at the time of their first simple febrile seizure have a 50% probability of having a second seizure. After 12 months, the probability decreases to 30%.
- Children who have simple febrile seizures are at an increased risk for epilepsy. The rate of epilepsy by age 25 years is approximately 2.4%, which is about twice the risk in the general population.
- The literature does not support the hypothesis that simple febrile seizures lower intelligence (ie, cause a learning disability) or are associated with increased mortality.
- Males have a slightly (but definite) higher incidence of febrile seizures.
- Simple febrile seizures occur most commonly in children aged 6 months to 5 years.
Clinical Manifestations
Children with febrile seizures exhibit the following:
- A generally healthy child. Children with simple febrile seizures are neurologically and developmentally healthy before and after the seizure.
- Seizures. They do not experience a seizure in the absence of a fever; the seizure is described as either a generalized clonic or a generalized tonic-clonic seizure.
- Occurrence of less than 15 minutes. Febrile seizure activity does not continue for more than 15 minutes, although a postictal period of sleepiness or confusion can extend beyond the 15-minute maximum.
Assessment and Diagnostic Findings
No specific studies are indicated for a simple febrile seizure.
- The focus. Physicians should focus on diagnosing the cause of fever.
- Underlying conditions. Other laboratory tests may be indicated by the nature of the underlying febrile illness; for example, a child with severe diarrhea may benefit from blood studies for electrolytes.
Medical Management
On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures.
- Therapy. Continuous therapy with phenobarbital or valproate decreases the occurrence of subsequent febrile seizures.
Pharmacologic Therapy
The following medications can be given to a child with febrile seizure:
- Benzodiazepine. These agents have antiseizure activity and act rapidly in acute seizures; oral diazepam can decrease the number of subsequent febrile seizures when given with each febrile episode; many practitioners will prescribe rectal diazepam, particularly to patients who have had prolonged febrile seizures, in order to prevent future episodes of febrile status epilepticus.
- Antipyretics. Although it does not prevent simple febrile seizures, antipyretic therapy is desirable for other reasons, for instance, comfort.
Nursing Management
Nursing care for a patient with febrile seizure includes the following:
Nursing Assessment
Assessment is necessary in order to identify potential problems that may have led to the condition as well as name any episode that may occur during nursing care.
- Identify the underlying cause. Identify the triggering factors; determination and management of the underlying cause are necessary for recovery.
- Assess the patient’s vital signs. Monitor the patient’s HR, BP, and especially the tympanic or rectal temperature.
- Assess age and weight. Extremes of age or weight increase the risk of the inability to control body temperature.
- Assess I&O status. Monitor fluid intake and urine output; fluid resuscitation may be required to correct dehydration.
Nursing Diagnoses
Based on the assessment data, the major nursing diagnoses are:
- Hyperthermia related to antigens or microorganisms that cause inflammation.
- Imbalanced nutrition related to an inability to meet the body’s daily energy needs.
- Ineffective tissue perfusion related to failure to nourish the tissues at the capillary level.
Nursing Care Planning and Goals
The goals for a patient with febrile seizure are:
- Patient’s temperature will decrease from [39°C] to normal range of [36.5°C to 37°C].
- Patient will be free of complications and maintain normal core temperature.
- Patient will identify measures to promote nutrition and follow the treatment regimen.
- Patient weight will be within normal values.
- Patient will demonstrate behavior lifestyle changes to improve circulation.
- Patient’s S.O. will verbalize understanding of the condition.
Nursing Interventions
Nursing interventions appropriate for the patient are:
- Check underlying factors. Assess the underlying condition and body temperature.
- Monitor vital signs. Monitor and record vital signs.
- Provide cold compresses. Provide a description of the family regarding the provision of a compress; cold compresses can reduce body temperature.
- Wear light clothing. Give light clothing that can absorb sweat to facilitate the release of heat into the air.
- Regulate activity. Promote adequate rest periods to reduce metabolic demands or oxygen.
- Increase fluid intake. Advice to increase fluid intake to help decrease body temperature.
- Discuss diet. Discuss eating habits and encourage diet for age to achieve the health needs of the patient with the proper food diet for his disease.
- Improve tissue perfusion. Elevate head of bed at night to increase gravitational blood flow.
Evaluation
Goals for the patient are achieved as evidenced by:
- Patient’s temperature decreased from [39°C] to normal range of [36.5°C to 37°C].
- Patient is free of complications and maintain normal core temperature.
- Patient identified measures to promote nutrition and follow the treatment regimen.
- Patient’s weight is within normal values.
- Patient demonstrated behavior lifestyle changes to improve circulation.
- Patient’s S.O. verbalized understanding of the condition.
Documentation Guidelines
Documentation for a patient with febrile seizure includes:
- Individual findings include factors affecting, interactions, the nature of social exchanges, and specifics of individual behavior.
- Cultural and religious beliefs, and expectations.
- Plan of care.
- Teaching plan.
- Responses to interventions, teaching, and actions performed.
- Attainment or progress toward the desired outcome.