When fever leads to seizures: What every parent needs to know

For Joan Wairimu, a mother of two, parenting had always come with its fair share of challenges, scraped knees, teething troubles, and the occasional fever.

Wairimu had handled all of it before with her firstborn. But nothing could have prepared her for what she witnessed with her youngest child.

It began subtly. Her two-year-old seemed a bit under the weather, slightly warm, a little sluggish, but nothing too alarming. Wairimu kept a close eye and gave paracetamol, expecting the fever to pass like it always had before.

But then the behaviour turned 'strange'.

"I noticed he was just sitting there, completely still," Wairimu recalled. "His eyes looked vacant - like he wasn't really there. Then, out of nowhere, he wet himself. He didn't even flinch."

Before she could fully process what was happening, the situation escalated.

"In a flash, he fell off the chair and started shaking violently," she said. "His body stiffened, his limbs were jerking uncontrollably—and then he bit his tongue. I thought I was watching my baby die."

Wairimu was frozen in shock. She had never witnessed a seizure before. And in her panic, one terrifying word echoed through her mind: epilepsy - a condition she had always feared.

But something didn't add up. There was no foam at the mouth, no warning signs like she'd heard about. Still, it didn't make the experience any less horrifying.

"I screamed. I didn't know what to do," she said, her voice trembling. "I thought, 'This can't be epilepsy... but then what is it?' I was terrified."

She scooped up her child and rushed to the nearest hospital. There, doctors explained that her child had experienced a febrile seizure, a convulsion triggered by a sudden spike in body temperature. It was something Joan had never even heard of before.

To make matters worse, she found out that the fever had been dangerously high and unmonitored for some time. The first signs had appeared while the child was in the care of a nanny. Though the nanny had mentioned the child seemed "a little off," she hadn't recognised the seriousness of the symptoms.

"When it happened again - this time right in front of me - I completely panicked," she admitted. "I tried everything: gave more paracetamol, fanned him, and prayed. But nothing felt like it was helping."

It wasn't just the seizure that left her shaken; it was the overwhelming helplessness. The fear of not knowing what was happening. The guilt of not being there earlier. The dread of watching her child suffer and not knowing how to make it stop.

"I've dealt with fevers before," she said. "With my older child, I'd give medication, rest would follow, and they'd bounce back. But this... this was something else entirely."

What are febrile seizures?

The Centres for Disease Control and Prevention (CDC) defines febrile seizures as convulsions triggered by fever in children. They are typically brief and occur in the context of an illness that causes a rise in body temperature.

According to Dr Esther Mwaura, a healthcare practitioner based in Nairobi, sudden spikes in body temperature remain one of the most common reasons for hospital visits among children. While fever is a typical part of childhood illnesses, she warns that if not carefully monitored, it can become dangerous, particularly in very young children.

Dr Mwaura emphasised that one of the biggest concerns is the confusion many parents have between febrile seizures and epilepsy.

"Many parents confuse febrile seizures with epilepsy, especially when there is visible jerking," Dr Mwaura explained. "But while the symptoms may appear similar, they are very different conditions."

She explained that febrile seizures often occur when a child's temperature suddenly rises to 40 degrees Celsius or more. During such an episode, the child may suddenly lose consciousness and experience convulsions characterised by stiffening of the body and jerking of the limbs.

The child may also bite their tongue or lose control of their bladder, which can be terrifying to witness, especially for first-time parents. These seizures typically last only a few minutes, usually less than five, and most children recover quickly without any lasting effects.

However, if a seizure lasts longer than five minutes, it becomes a medical emergency, and parents should seek immediate medical help.

Dr Mwaura advised that, in such cases, urgent treatment is necessary to prevent complications.

She further clarified that febrile seizures are not a form of epilepsy. Epilepsy, she says, is a neurological disorder more commonly seen in adults, although it can sometimes begin in childhood—often due to complications during birth or head injuries that affect the brain. Febrile seizures, on the other hand, are typically brief and caused by fever, and they do not indicate an underlying neurological disease.

In managing high fever, Dr Mwaura stressed the importance of timely action. Parents are encouraged to monitor their child's temperature closely and respond as soon as they notice a fever. In cases of high fever, especially when the child is too ill to take oral medication, she recommends using fever-reducing medicine in suppository form.

She also urged applying a wet cloth on the child's back and neck to help bring the fever down, while ensuring the child remains hydrated and calm. If the fever does not reduce or the child experiences a seizure, immediate medical attention is crucial.

If a child begins to convulse, Dr Mwaura said it is important for parents to remain calm. The child should be laid flat on a safe surface, away from objects that could cause injury. If possible, the child should be gently turned on their side to keep the airway open.

She strongly warned against putting anything in the child's mouth or trying to restrain them, as these actions could cause more harm. After the seizure ends, the child should be taken to a healthcare facility as soon as possible, especially if the episode lasts longer than five minutes.

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"Parents should not panic. Febrile seizures, while frightening, are usually harmless and do not mean a child has epilepsy. The key is to monitor the fever, act quickly, and seek medical help when needed."

Pharyngotonsillitis

A study, published in 2020 by researchers from the University of Nairobi and Kenyatta National Hospital, revealed that 30.3 per cent of pediatric patients presenting with febrile seizures were diagnosed with acute otorhinolaryngological (ENT) infections. Among these infections, pharyngotonsillitis, an inflammation of the throat and tonsils, was identified as the most common trigger.

This finding is particularly important because it highlights a specific infection that parents and healthcare providers should watch for as a potential cause of fever-related seizures in children.

Pharyngotonsillitis often leads to high fevers, which can precipitate febrile seizures in susceptible children, especially those between six months and five years of age. The prevalence of this infection in children with febrile seizures underscores the critical need for prompt diagnosis and treatment of throat infections to prevent the development of seizures.

Additionally, the study found that simple febrile seizures were more common than complex febrile seizures. Simple febrile seizures typically last less than 15 minutes, involve generalised shaking or convulsions affecting the whole body, and do not recur within 24 hours. These seizures generally have a good prognosis and do not usually lead to neurological damage or epilepsy.

On the other hand, complex febrile seizures are longer-lasting, may affect only one part of the body, and can recur within 24 hours. Although less frequent, these types of seizures are often a cause for concern because they can indicate an increased risk for future epilepsy or neurological complications.

The predominance of simple febrile seizures in the study population is somewhat reassuring. It suggests that most children experiencing febrile seizures due to infections like pharyngotonsillitis are likely to have a benign course with appropriate treatment and care.

This study's findings emphasise the importance of early detection and management of infections, particularly ENT infections, in young children.

Globally, febrile seizures are the most common type of seizure in children. In industrialised countries, the prevalence ranges from 2 per cent to 5percent among children aged six months to five years.