Seizures in Children (cont.)
When to Seek Medical Care for Seizures in Children
All children who seize for the first time and many with a known seizure disorder should be evaluated by a doctor.
- Most children with first seizures should be evaluated in a hospital's emergency department. However, if the seizure lasted less than 2 minutes, if there were no repeated seizures, and if the child had no difficulty breathing, it may be possible to have the child evaluated at the pediatrician's office.
- After the seizure has stopped and the child has returned to normal, contact your child's doctor for further advice. Your pediatrician may recommend either an office or an emergency department visit. If you do not have a pediatrician or none is available, bring the child to the emergency department. If you are worried about possible absence seizures, evaluation at the pediatrician's office is appropriate.
- Caregivers of children with epilepsy should contact the child's pediatrician if there is something different about the type, duration, or frequency of the seizure. The doctor may direct you to the office or to the emergency department.
- Take the child to the emergency department or call 911 if you are concerned that your child was injured during the seizure or if you think that he or she may be in status epilepticus (seizures of any kind that do not stop).
Most children who have seized for the first time should be taken to the emergency department for an immediate evaluation.
- Any child with repeated or prolonged seizures, trouble breathing, or who has been significantly injured should go to the hospital by ambulance.
- If the child has a history of seizures and there is something different about this one, such as duration of the seizure, part of body moving, a long period of sleepiness, or any other concerns, the child should be seen in the emergency department.
How to Test for Seizures in Children
For all children, a thorough interview and examination should occur. It is important for the caregiver to tell the doctor about the child's medical history, birth history, any recent illness, and any medications or chemicals that the child could have been exposed to. Additionally, the doctor asks for a description of the event, specifically to include where it occurred, how long any abnormal movements lasted, and the period of sleepiness afterward. A wide variety of tests can be performed on a child who is thought to have seizures. This testing depends on the child's age and suspected type of seizures.
- Children should receive medication for the fever such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil).
- Depending on the age of the child, the doctor may order blood or urine tests or both, looking for the source of the fever.
- If the child has had his or her first febrile seizure, then the doctor may want to perform a lumbar puncture (spinal tap) to test for possible meningitis. The lumbar puncture should be performed in children younger than 6 months, and some doctors perform them in children as old as 18 months.
- Most children do not get a CT scan of the head, unless there was something unusual about the febrile seizures, such as the child not returning to his or her normal self shortly afterward.
- Very few children with febrile seizures are admitted to the hospital. The treatment for febrile seizures is keeping the temperature down, and possibly a medication if a specific infection is found such as an ear infection. Follow up with the child's doctor in a few days.
- Movement seizures, which include partial seizures and generalized (grand mal) seizures, can be very dramatic. If the child is having a seizure in the emergency department, he or she is given medications to stop the seizure.
- If the child has returned to normal in the hospital, then the child will probably have a few tests performed. Blood is drawn to check the child's sugar, sodium, and some other blood chemicals.
- If the child is on antiseizure medications, then the medication's levels in the blood are checked (if possible).
- Most children undergo a CT scan or MRI (studies looking at the structure of the brain), but this may be scheduled for several days later rather than in the emergency department. In children, these imaging studies are usually normal but are performed to look for unusual causes of seizure such as bleeding or tumor.
- Most children eventually undergo an EEG, which is a study looking at the brain waves or electrical activity of the brain. An EEG is almost never performed in the emergency department but is performed later.
- The child will probably be admitted if he or she is very young, has another seizure, has abnormal physical examination findings or lab test results, or if you live far from a hospital. Children in status epilepticus are admitted to an intensive care unit.
- If the child is doing well, doesn't have recurring seizures, and has a normal physical examination findings and blood test results, then the child will most likely be sent home to follow up with a pediatrician in a few days to continue the evaluation and arrange other tests, such as the EEG.
Absence seizures (petit mal)
- These can be evaluated without going to an emergency department. Most likely, the doctor will only order an EEG. If the EEG tells the doctor that the child is having absence seizures, then the child will most likely be placed on medications to control them.
- Neonatal seizures and infantile spasms
- Seizures of this type occur in young children and are often associated with other problems such as mental retardation. Children suspected of having these seizures may have multiple lab tests done in the emergency department. They would include blood and urine samples, lumbar puncture, and possibly a CT scan of the head. These children are usually admitted to the hospital and may even be referred to a pediatric specialty hospital. In the hospital, these children undergo several days of testing to look for the many possible causes of the seizures.
Medically Reviewed by a Doctor on 10/18/2016
Frank L Christopher, MD, FAAEM
Robert R Westermeyer II, MD, FAAEM
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
Thomas Rebbecchi, MD, FAAEM
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