Seizure
Fits, seizures and convulsions generally mean the same thing.
Seeing a child or young person having a fit can be frightening. Most fits do not cause serious harm. The commonest type of fit in children is a febrile convulsion. This is a fit associated with a high temperature. This sort of fit tends to occur in younger children. Fits sometimes occur without a fever (afebrile fit or seizure). If your child has had only one afebrile fit, it does not always mean they have epilepsy. Many children will never have another one.
First aid for a convulsive seizure:
A convulsive seizure is where the child is stiff or shaking. The information below can help you to focus when your child is having a seizure. It can help you to give first aid to keep them safe:
Do
- Stay calm
- Protect them from injury (remove harmful objects from nearby)
- Cushion or gently hold your child’s head to protect them from head injury
- Note the date and time the seizure started. If stiffness and jerking continues for 5 minutes or more you should call 999 for an ambulance
- Turn your child onto their side, into the recovery position (see below) as soon as you are able (as shown in Image 1). This can help with their breathing and help if they vomit or have other types of fluid in their mouth. Some noisy breathing and slight colour change is common
- If possible, try to video the seizure on a mobile phone as it can provide a lot of useful information to your child’s doctor or nurse. Video can help confirm the type of seizure which then helps decide which tests and treatment may be needed. Try to capture the whole child in the video, say out loud what you are seeing and show how they respond to you
- Stay with your child until they are fully recovered
- Your child may be confused, drowsy or fall asleep after a seizure. Reassure them if they are confused, let them rest or sleep if they are drowsy, make sure you keep an eye on them until they are fully recovered
Do not
- Restrain or restrict your child’s movements
- Move your child unless they are in danger
- Put anything in their mouth
- Give your child anything to eat or drink until they have fully recovered
Call 999 for an ambulance if:
- The stiffness or jerking continues for 5 minutes or more
- One seizure follows another before your child has fully recovered
- Your child is injured, or you are worried about their breathing
Please see Red-Amber-Green tables for advice on when and where to seek care for your child.
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When should you worry?
Newborn
NEWBORN
Contact your health visitor or GP if your baby is newborn and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Don’t have a Grasp Reflex (doesn’t grab your finger or small object when you put it in their hand)
- Are often startling and you cannot understand why
- Move one side of their body more than the other, for example:
- Rarely moves one of their arms compared to the other arm
- Rarely moves one leg compared to the other leg
- When your baby startles, one side moves or looks different from the other
6-8 weeks
6-8 WEEKS
Contact your health visitor or GP if your baby is 6-8 weeks and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
2-3 months
2-3 MONTHS
Contact your health visitor or GP if your baby is 2-3 months and they…
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm into their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You may also find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy, or have floppy arms or legs when awake
- Move their arms and legs in repetitive jerky movements, or writhing movements
- Have not started to bring both their hands to their face, or do not move their arms much
- Keep their hands fisted, and you find it difficult to open their hands
- Can’t lift their head when lying on their tummy
- Move one side of their body more than the other, for example:
- Mostly moves one arm or mostly brings one hand to their face
- Rarely kicks or moves one leg compared to the other leg
3-4 months
3-4 MONTHS
Contact your health visitor or GP if your baby is 3-4 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Prefer to keep their arms by their sides. For example, they do not reach for things, or do not bring their hands together over their face or tummy
- Move their arms or legs in repetitive, jerky, or strange ways
- Still need you to support their head, or can’t lift their head when lying on their tummy
- Have very tight fists and it’s hard to open their hand
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
4-6 months
4-6 MONTHS
Contact your health visitor or GP if your baby is 4-6 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys
- Rarely kick one leg compared to the other
- Are unable to roll, or can roll in one direction but not the other
- Find it difficult to reach their arms out. For example, they do not reach for toys
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back. For example, they do not bring their feet to their chest
- Still need you to support their head
6-9 months
6-9 MONTHS
Contact your health visitor or GP if your baby is 6-9 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky or strange ways
- Move one side of their body more than the other, for example:
- Rarely use one of their arms to pick up toys, or eat and drink
- Rarely kick one leg compared to the other
- Can’t sit without support. For example, they lean on their hand, or, when they sit, their back is very curved
- Still have their early reflexes, like the startle reflex and grasp reflex
- Keep their legs flat when lying on their back, for example, do not bring their feet to their chest
- Still need you to support their head
- Still need you to help turn their head when lying on their back
- Can’t crawl, or find it hard, for example, drags one of their legs behind them
- Find it difficult to stand, for example:
- Can’t stand with support
- Doesn’t try to pull themselves up to stand
- Can’t move a toy from one hand to the other
- Doesn’t use both hands to hold larger things
9-12 months
9-12 MONTHS
Contact your health visitor or GP if your baby is 9-12 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms and legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink.
- Rarely kick one leg compared to the other
- Find it difficult to sit, for example:
- Only sit with support
- Lean on their hand when sitting
- When they sit their back is very curved
- Can’t move a toy from one hand to the other
- Don’t use both hands to hold larger things
- Don’t point to objects
- Can’t crawl, or find it hard, for example, drags one leg behind them
- Find it difficult to stand, for example:
- Can’t pull themselves up to stand
- Find it hard to pull themselves up. For example, they only use their arms and don’t push with their legs
- Can’t stand with support
2 months
Your Baby By Two Months
Social/Emotional Milestones
- Calms down when spoken to or picked up
- Looks at your face
- Seems happy to see you when you walk up to her
- Smiles when you talk to or smile at her
Language/Communication Milestones
- Makes sounds other than crying
- Reacts to loud sounds
Cognitive Milestones (learning, thinking, problem-solving)
- Watches you as you move
- Looks at a toy for several seconds
Movement/Physical Development Milestones
- Holds head up when on tummy
- Moves both arms and both legs
- Opens hands briefly
4 months
Your Baby By Four Months
Social/Emotional Milestones
- Smiles on his own to get your attention
- Chuckles (not yet a full laugh) when you try to make him laugh
- Looks at you, moves, or makes sounds to get or keep your attention
Language/Communication Milestones
- Makes sounds like “oooo”, “aahh” (cooing)
- Makes sounds back when you talk to him
- Turns head towards the sound of your voice
Cognitive Milestones (learning, thinking, problem-solving
- If hungry, opens mouth when he sees breast or bottle
- Looks at her hands with interest
Movement/Physical Development Milestones
- Holds head steady without support when you are holding him
- Holds a toy when you put it in his hand
- Uses his arm to swing at toys
- Brings hands to mouth
- Pushes up onto elbows/forearms when on tummy
6 months
Your Baby By Six Months
Social/Emotional Milestones
- Knows familiar people
- Likes to look at self in a mirror
- Laughs
Language/Communication Milestones
- Takes turns making sounds with you
- Blows “raspberries” (sticks tongue out and blows)
- Makes squealing noises
Cognitive Milestones (learning, thinking, problem-solving)
- Puts things in her mouth to explore them
- Reaches to grab a toy she wants
- Closes lips to show she doesn’t want more food
Movement/Physical Development Milestones
- Rolls from tummy to back
- Pushes up with straight arms when on tummy
- Leans on hands to support herself when sitting
9 months
Your Baby By Nine Months
Social/Emotional Milestones
- Is shy, clingy, or fearful around strangers
- Shows several facial expressions, like happy, sad, angry, and surprised
- Looks when you call her name
- Reacts when you leave (looks, reaches for you, or cries)
- Smiles or laughs when you play peek-a-boo
Language/Communication Milestones
- Makes a lot of different sounds like “mamamama” and “bababababa”
- Lifts arms up to be picked up
Cognitive Milestones (learning, thinking, problem-solving)
- Looks for objects when dropped out of sight (like his spoon or toy)
- Bangs two things together
Movement/Physical Development Milestones
- Gets to a sitting position by herself
- Moves things from one hand to her other hand
- Uses fingers to “rake” food towards himself
- Sits without support
1 year
Your Baby By One Year
Social/Emotional Milestones
- Plays games with you, like pat-a-cake
Language/Communication Milestones
- Waves “bye-bye”
- Calls a parent “mama” or “dada” or another special name
- Understands “no” (pauses briefly or stops when you say it)
Cognitive Milestones (learning, thinking, problem-solving)
- Puts something in a container, like a block in a cup
- Looks for things he sees you hide, like a toy under a blanket
Movement/Physical Development Milestones
- Pulls up to stand
- Walks, holding on to furniture
- Drinks from a cup without a lid, as you hold it
- Picks things up between thumb and pointer finger, like small bits of food
RED
RED
If your child has any of the following:
- Is under 1 year of age
- The first time your child has had a fit (seizure)
- Has a fit that lasts longer than 5 minutes
- They have one fit after another without being awake in between
- They are seriously injured during the fit
- Remain drowsy or confused more than an hour after their fit
- Has weakness of the arms or legs, visual difficulties (double vision) or difficulty speaking after the fit has stopped
- They have trouble breathing after the fit has stopped
- Breathing very fast or breathing that stops or pauses
- Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
- Becomes pale, blue, mottled and/or unusually cold to touch
- Has a rash that does not go away with pressure (the glass test)
You need urgent help.
Go to the nearest Hospital Emergency (A&E) Department or phone 999 - consider using ‘What 3 words’ to best describe location to ambulance service
AMBER
AMBER
If your child has any of the following:
- Has another fit (less than 5 minutes) within the same illness
- Breathing a bit faster than normal or working a bit harder to breathe
- Dry skin, lips, tongue or looking pale
- Not had a wee or wet nappy in last 12 hours
- Poor feeding in babies (less than half of their usual amount)
- Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
- A temperature 39oC or above in babies 3-6 months
- Temperature of 38oC or above for more than 5 days or shivering with fever (rigors)
- Getting worse and I am still worried
You need to contact a doctor or nurse today.
Please contact your GP surgery or call NHS 111 - dial 111.
If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.
AMBER
AMBER
Green
Green
If none of the above features are present
Seizure lasting less than 5 minutes with full recovery in a child with previous febrile convulsions or known epilepsy
- Watch them closely for any change and look out for any red or amber symptoms
- If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.
Self care
Continue providing your child’s care at home. If you are still concerned about your child, speak to your health visitor, local pharmacist or call NHS 111– dial 111.
Advice and Guidance
Self care and Prevention
Fits associated with fever (febrile convulsion)
Febrile convulsions occurs in some children with a high temperature (fever). Although it can be extremely scary the first time you see your child have one, most of the time they are not serious. Most occur with common illnesses such as ear infections, colds and other viral infections. Full recovery with no permanent damage is usual.
The main treatment is aimed at the illness that caused the fever.
Who gets them?
- They occur in about 1 in 20 children, most commonly between 6 months and 6 years of age.
- They often occur on the first day of an illness associated with fever. There appears to be no connection between how high a child’s fever is and whether they have a fit. They can occur even with mild fevers.
- Most children will not have another fit during the same illness.
- 1 in 3 children who have a febrile convulsion may go on to have further febrile convulsions in the future. This is more likely if other members of the family have had febrile convulsions.
- Febrile convulsions are not epilepsy. Regular treatment for prevention of future fits is usually not necessary. There is a small risk of your child developing epilepsy in the future and many parents worry about this, however, most children who have childhood simple febrile convulsions grow out of them and do not develop epilepsy.
- If your child has had a previous febrile convulsion, has a clear cause for their fever, their seizure stops quickly and they are back to normal soon after, they may be cared for at home. The first time your child has a fit, you should go to your local Emergency Department or call an ambulance.
- Once they have been examined, if a cause is found and your child is well, it may be appropriate that they are discharged to continue recovering at home.
What should you do?
When the fit stops, you can give them Paracetamol or Ibuprofen. However, this might not stop them having another one. Always follow instructions on the container and do not exceed daily maximum doses
For more information on fever, please visit our page.
How long will the symptoms last?
In most cases, children with simple febrile convulsions appear dazed and their eyes may roll back.
Their bodies may go stiff, their arms and legs may twitch or shake and they will become unresponsive for a few seconds. It is unusual for the febrile convulsion to last for more than 5 minutes.
Your child may be sleepy for a few minutes afterwards.
Fits not associated with fever (afebrile fits and seizures):
If your child has had only one afebrile fit, it does not always mean they have epilepsy. Some children will never have another one.
Children can have events that look very similar to a seizure, but they are not; these include faints, tics, day dreams, sleep disorders and breath-holding attacks. However, if your child has more than one fit, they will need to investigate for possible epilepsy.
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