What do seizures look like in infants

Neonatal (Newborn) Seizures | Conditions

Critical Care Pediatric Brain Center

Overview
Causes
Signs & symptoms
Diagnosis
Treatment
Where to get care
Recommended reading
Support services

Overview

A seizure is caused by sudden, abnormal and excessive electrical activity in the brain. By definition, neonatal seizures occur during the neonatal period — for a full-term infant, the first 28 days of life. Most occur in the first one to two days to the first week of a baby's life. Premature or low birth weight babies are more likely to suffer neonatal seizures.

Many of the visible signs of neonatal seizures — such as chewing motions and "bicycling" movements — also occur in healthy newborns. Therefore, testing is usually required to confirm the diagnosis.

The outcomes for babies who have neonatal seizures depend on the type of seizure and the underlying cause. Some neonatal seizures are mild and short-lived and therefore do not cause any lasting health problems. However, prolonged and untreated seizures can cause permanent damage due to decreased oxygen flow to the brain and excessive brain cell activity. Neonatal seizures are often symptoms of a more serious underlying condition, particularly brain injury. For this reason, babies experiencing neonatal seizures should receive rapid, specialized care.

About half of all babies who have neonatal seizures will develop epilepsy later in life. Those with seizures related to brain injuries or developmental abnormalities may have further complications, such as cerebral palsy, mental retardation and other neurological disorders. These conditions result from the underlying brain damage, not the seizure itself.

Causes

Neonatal seizures have a variety of causes. These include:

Lack of oxygen before or during birth due to placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labor, or compression of the umbilical cord
Infection acquired before or after birth, such as bacterial meningitis, viral encephalitis, toxoplasmosis, syphilis or rubella
Stroke before or after birth
Blood clot in the brain
Bleeding in the brain
Brain birth defects
Blood sugar or electrolyte imbalances
Metabolic disorders such as maple syrup urine disease, pyridoxine dependency or phenylketonuria (PKU)
Drug withdrawal, which may affect babies born to mothers addicted to barbiturates, alcohol, heroin, cocaine or methadone

In rare cases, neonatal seizures are caused by a condition called benign familial neonatal seizures, also known as fifth-day convulsions or fifth-day fits. This condition is inherited, and the baby's mother or father will also have had the disorder. Many babies with benign familial neonatal seizures develop normally, although some may have developmental delays that are seen in early childhood.

Signs & symptoms

Neonatal seizures can be difficult to diagnose because the seizure may be short and subtle. In addition, symptoms of neonatal seizures may mimic normal movements and behaviors seen in healthy babies.

Symptoms depend on the type of seizure — subtle, clonic, tonic or myoclonic.

Symptoms of Subtle Seizures

Subtle seizures are more common among full-term babies. Symptoms of subtle seizures include:

Random or roving eye movements, eyelid blinking or fluttering, eyes rolling up, eye opening, staring
Sucking, smacking, chewing and protruding tongue
Unusual bicycling or pedalling movements of the legs
Thrashing or struggling movements
Long pauses in breathing (apnea)

Symptoms of Clonic Seizures

Rhythmic jerking movements that may involve the muscles of the face, tongue, arms, legs or other regions of the body

Symptoms of Tonic Seizures

Stiffening or tightening of the muscles
Turning the head or eyes to one side, or bending or stretching one or more arms or legs

Symptoms of Myoclonic Seizures

Quick, single jerking motions, involving one arm or leg or the whole body

Diagnosis

A test called an electroencephalogram (EEG) is essential for diagnosing and managing neonatal seizures. EEG records the electrical activity of the brain, and abnormalities on an EEG test (measured between seizures) can indicate a risk for seizures. However, babies with benign familial neonatal seizures usually have normal EEG readings.

Imaging tests of the brain, including magnetic resonance imaging (MRI) and computed tomography (CT) scan, are also used to determine the cause of seizures.

Treatment

Prompt diagnosis and treatment of neonatal seizures is essential. Your baby's health care team will also work to identify and treat any underlying cause of the seizures.

To control the seizures, anticonvulsant medications may be prescribed, including phenobarbital, lorazepam and phenytoin. Your baby will be closely monitored at all times while receiving these medications.

Babies suffering from hypoxic ischemic encephalopathy (not enough oxygen to the brain) may receive hypothermia treatment, which may reduce brain damage caused by the lack of oxygen. Hypothermic treatment involves cooling the baby's brain and body by a few degrees immediately after birth for several hours or days. Babies are closely monitored during treatment, and then slowly re-warmed to normal body temperature.

UCSF Benioff Children's Hospitals medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your child's doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your child's provider.

Where to get care (1)

San Francisco / Oakland

Our research initiatives

Awards & recognition

Learning never stops

Our classroom and bedside classes help kids get credit and keep learning during treatment.

See our school program

What Are Infant Seizures? How Do I Know If My Baby Is Having One?

Disclaimer: We cannot provide treatments or medical advice. Please call 911, your country’s emergency number, or your doctor if you may be having a medical emergency.

What’s causing my baby’s seizures?

Many different conditions and injuries can cause a baby’s seizures. A The most common cause of seizures in newborn infants is brain damage from illness or injury, such as hypoxic-ischemic encephalopathy (HIE) (5). For more details on HIE and other causes of seizures, including infections, traumatic brain injury, or prolonged second stage of labor, click here. HIE also has its own set of possible causes, which are listed here.

Other causes include (5):

Brain bleed or hemorrhage
Stroke
Brain tumor
Infection such as meningitis, encephalitis.

Diagnosis and prompt treatment is typically made in the NICU.

If seizures occur after discharge from the hospital, it is absolutely imperative that parents inform their child’s doctors of possible seizures immediately so that their child can receive proper diagnosis and treatment as soon as possible.

Infant seizures can be a result of medical malpractice.
Our legal team has fought on behalf of children to obtain the justice and compensation they deserve.

Get a free consultation

I have seen adults have seizures before. Is this what it will look like if my child has a seizure?

Not necessarily. According to the Epilepsy Foundation, seizures in newborn babies can look very different from those that occur in older children and adults. Sometimes, parents think a healthy baby is having a seizure when they are, in fact, exhibiting something called the Moro reflex, which can occur if a baby is startled, or has jitters (1). These can look similar to shivering. On the other hand, when a baby is really having a seizure, it can be very difficult to recognize. Therefore, it is very important for parents to speak to a doctor about any concerns, even if they seem silly. It is your doctor’s job to answer your questions and run diagnostic tests if you have witnessed signs of a seizure.

What do infant seizures look like? How will I know if my baby is having a seizure?

Some of the signs of infant seizures include (1, 2):

Tonic seizures: Parts (or all) of the infant’s body can stiffen suddenly. For an example of how a tonic seizure might look, click here.
Myoclonic seizures: A group of muscles in the infant’s body may all start to jerk in clusters several times each day and for a few days in a row. These muscle groups are usually in the shoulders, neck, or upper arms. This is called a myoclonic seizure. For an example of how a myoclonic seizure might look, click here.
Febrile seizures: The infant’s limbs may either stiffen or twitch and jerk, and their eyes may roll. These seizures are the most common type of infant seizures and are usually caused by a fever above 102 degrees. For an example of how a febrile seizure might look, click here.
Atonic seizures: The infant may suddenly go limp and unresponsive, as in dropping their head suddenly or falling suddenly to the floor while crawling or walking. For an example of how an atonic seizure might look, click here.
Absence seizure: The infant may appear to have short episodes of staring into space, blinking their eyes quickly, or moving their mouth as if chewing. This is called an absence seizure. For an example of how an absence seizure might look, click here.
Focal seizures: Focal seizures may involve the infant having spasms or rigidity in one muscle group, becoming pale, sweating, vomiting, screaming, crying, gagging, smacking their lips, or becoming unconscious. For an example of how a focal seizure might look, click here.
Infantile spasm: The infant may experience spasms characterized by stiffening of the arms and legs, bending forward, and arching of the back. This rarer form of seizures usually occurs between 4-8 months of birth. For an example of how an infantile spasm might look, click here.

How I can I be sure my child is having a seizure?

Because many signs and symptoms of seizures are similar to the normal movements and actions of infants, it may be difficult to tell if your infant is experiencing one. It is imperative that you speak to a doctor if you think your child may be having seizures. If possible, one parent may be able to take a video of the child having a seizure to show the doctors while the other parent takes the necessary precautions to ensure the baby’s safety during a seizure. If a camera (or phone with videotaping ability) is not available, or only one parent/adult is present, it is important to remain as calm as possible, prioritize the baby’s immediate safety, and observe the baby carefully so that you can report what you see to the doctor. Your observations can help doctors determine whether a baby is having a seizure, what type of seizure they are having, what caused it, and what sort of treatment the baby may require. Of course, physicians should also run diagnostic tests such as electroencephalogram (EEG), rather than relying exclusively on parents’ observations.

If you believe your child may be having their first seizure, call 911 or take them to the emergency room. If they have had seizures before, your doctor can provide you with information on how to distinguish between seizures that warrant a trip to the hospital and those that do not.

How can I help my child during a seizure?

There are a few key steps to take if you think your infant is having a seizure. Parents Magazine recommends the following to keep your baby as safe as possible during a seizure (2, 3):

- Make sure your infant is protected from experiencing injuries by moving hard objects out of the way.
- Gently roll your baby onto their side to help prevent choking.
- Avoid trying to open the baby’s mouth, putting anything in their mouth, holding them, or preventing movements (including tongue biting).
Call 911 if your baby has a seizure for more than 5 minutes, turns blue, has trouble breathing, or is unresponsive after the seizure ends.

For detailed advice on when to call 911, please see these recommendations from the CDC or the Epilepsy Foundation.

Will my doctor be able to know for sure if my child is having seizures?

If you suspect that your baby is having seizures, the pediatrician will typically refer you to a pediatric neurologist. Your baby’s pediatric neurologist may order and perform a number of tests to narrow down the type of seizures and their causes. The following tests can help diagnose infant seizures (4):

An EEG to look for abnormal activity in the brain.
An MRI of the head to look for structural abnormalities in the brain.
Chromosomal studies to look for genetic disorders.
A spinal tap to look for infection, chemical disorders, or metabolic disorders.
Blood or urine tests to look for metabolic issues or chemical disorders.

What possible treatments are there for infant seizures?

According to Core Curriculum for Neonatal Intensive Care Nursing: Fifth Edition, patient care management for infant seizures involves the following, in sequential order (6):

Determining the cause of the seizures
Obtaining diagnostic studies as ordered
Providing pharmaceutical therapy

If the cause of seizures is HIE, cooling therapy is initiated.

The most common treatment for seizures is anti-seizure medications. These may also be referred to as antiepileptic drugs or AEDs. There are many types of AED that may be prescribed, depending on age, type of seizure, frequency of seizure, and other variables. Narrow spectrum AEDs are designed for specific types of seizures occurring in a certain part of the brain. Broad spectrum AEDs can prevent seizures that occur in multiple parts of the brain. Healthline provides more detailed information about AED types.

Some children with seizures may benefit from cannabidiol (CBD) oil, which is derived from the cannabis plant, but does not have the psychogenic effects associated with strains used as a recreational drug. Many patients report fewer overall side effects from CBD than other seizure medications. To learn more about this treatment, click here.

It is important to know that CBD may react negatively with certain AEDs. It is also very important for parents to be aware that in some states, it is illegal to give children CBD or other cannabis products, and child protective services may become involved if they are reported. However, state laws are rapidly changing, and many have recently legalized cannabis products for seizures and/or other medicinal purposes.

In some cases, doctors may also recommend the ketogenic diet, which is high in protein and fat, and low in carbohydrates. The ketogenic diet causes the child’s body to produce ketones, which help to control seizures.

Some children may also benefit from vagus nerve stimulation (VNS), which involves surgical implantation of a magnet-controlled device that can prevent seizures.

Finally, if a child’s seizures are unmanageable by other means, they may need surgery to remove the part of the brain causing seizures. Of course, it is very important to carefully consider other functions that may be affected by brain surgery, and weigh the pros and cons. See the Stanford Children’s Health website for more information on the treatment of seizures in children.

Disclaimer: The HIE Help Center does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this web site. The HIE Help Center is not responsible nor liable for any advice, course of treatment, diagnosis, or any other information, services, or products that you obtain through this website.

Related Reading: HIE and Seizures

Epilepsy, Seizures and Seizure Disorders
Seizure Dogs
Diagnosing HIE

About the HIE Help Center

The HIE Help Center is sponsored by ABC Law Centers, a medical malpractice firm exclusively handling cases involving HIE and other birth injuries. Our lawyers have over 100 years of combined experience with this type of law, and have been advocating for children with HIE and related disabilities since the firm’s inception in 1997.

We are passionate about helping families obtain the compensation necessary to cover their extensive medical bills, loss of wages (if one or both parents have to miss work in order to care for their child), assistive technology, and other necessities.

If you suspect your child’s injury may have been caused by medical negligence, please contact us today to learn more about pursuing a case. We provide free legal consultations, during which we will inform you of your legal options and answer any questions you have. Moreover, you would pay nothing throughout the entire legal process unless we win or settle your case.

Sources:

Authored By: James W. Wheless MDJoseph I. Sirven MD. (2013, August 27). Seizures in Newborns. Retrieved June 21, 2020, from https://www.epilepsy.com/learn/seizures-youth/about-newborns-and-infants/seizures-newborns
Chancellor, B. U. (2018, December 04). Signs of Seizures in Babies. Retrieved from https://www.parents.com/baby/health/other-issues/signs-of-seizures-in-babies/
Seizure First Aid. (2014, March 19). Retrieved August 14, 2020, from https://www.epilepsy.com/living-epilepsy/parents-and-caregivers/about-kids/seizure-first-aid
Authored By: James W. Wheless MDJoseph I. Sirven MD. (2013, August 27). Diagnosis of Infant Seizures. Retrieved August 14, 2020, from https://www.epilepsy.com/living-epilepsy/parents-and-caregivers/about-newborns-and-infants/diagnosis-infant-seizures
Seizures and Epilepsy in Children. (n.d.). Retrieved August 14, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/seizures-and-epilepsy-in-children
Verklan, T. M., & Walden, M. (2015). Core Curriculum for Neonatal Intensive Care Nursing (5th ed.). Elsevier. doi:https://www.elsevier.com/books/core-curriculum-for-neonatal-intensive-care-nursing/verklan/978-0-323-22590-8

Download this page as PDF

Febrile convulsions in children | Rassvet Clinic

Febrile convulsions (attacks) are episodes of convulsions in children accompanied by high fever.

Seizure may occur up to 4%:

in a child aged 6 months to 5 years with no prior neurological problems;
when the temperature rises above 38 ⁰C.

What can cause an attack?

Infections that cause fever. nine0016 Infection can be caused by bacteria, but febrile seizures are more common with viral illnesses (eg, roseola and influenza).

Vaccinations followed by fever. There is a small chance of febrile seizures after vaccination against measles, rubella and mumps, as well as diphtheria, tetanus and whooping cough. But the risks from incomplete vaccination are higher than the risk from a febrile seizure after vaccination.

Heredity. If either parent has had a febrile seizure, the child is more likely to have a fever seizure. nine0003
A febrile seizure, especially when it occurs for the first time in life, is very frightening for parents. In fact, most of these attacks are not dangerous, do not lead to complications and damage to the brain. A child with a simple febrile seizure is only marginally more likely to develop epilepsy than a child who has never experienced a febrile seizure.

What does a simple febrile seizure look like?

The child loses consciousness, does not respond, may roll his eyes up. nine0008
Arms and legs twitch rhythmically, this happens symmetrically on both sides.

The attack usually lasts less than a minute, but in some cases - up to 5 minutes.

After an attack, the child may be drowsy for an hour, but does not feel weakness in the arm or leg and gradually returns to normal.

What are complex febrile seizures? How are they different from normal ones?

In this type of febrile seizure, the seizure may begin with a twitch of one arm (leg) or with a turn of the head to one side (asymmetry). nine0003

An attack may last longer than 15 minutes, or attacks may recur several times a day.

An attack can occur at a relatively low temperature, below 38 ⁰C.

After an attack, there may be prolonged drowsiness, weakness in one arm or leg.

How to help a child during an attack?

Lay the baby on its side on a flat surface and make sure that the child does not fall or hit anything during the cramp (eg the crib bars). nine0008
Time yourself and tell your doctor when the attack started and how long it lasted.

Attention! Do not try to open the jaw, do not put anything in the child's mouth during an attack, this can lead to injuries (broken teeth of the child and injured fingers of the caregiver).
Do not try to restrict the movement of the child during convulsions, do not restrain him.

The child may be even more afraid of an attack than the parents. Try to calm him down, support him. nine0070
If the seizure occurs for the first time in life, lasts longer than 5 minutes, the child is unusually drowsy and lethargic before or after the seizure, call an ambulance.

In other cases, take the child to the pediatrician without delay. The doctor should examine the child after the attack and make sure that he does not have signs of a central nervous system infection (meningitis or encephalitis).

What tests are done after a febrile seizure?

In most cases, a doctor's examination is sufficient to make this diagnosis. If meningitis is suspected, a lumbar puncture is performed. Sometimes the doctor may order urine and blood tests if the cause of the high fever is not clear. nine0003
In case of complex seizures, electroencephalography and MRI are scheduled. These studies are necessary because this type of febrile seizure may be a manifestation of rare epileptic syndromes that require anticonvulsant treatment.

How to treat a fever in a child who has previously had a febrile seizure?

If the child does not have a fever during illness or after vaccination, it is not recommended to give antipyretics! It does not reduce the risk of an attack. nine0003
If the fever is high, anti-fever medications make you feel better overall, but do not help the attacks.

The harm of anticonvulsants for the prevention of febrile seizures outweighs the benefits, they are almost never prescribed.

If the child's febrile seizures are prolonged, it is recommended to administer a benzodiazepine enema, nasal spray, or cheek gel at the onset of the seizure. Unfortunately, none of these forms is registered in Russia. Therefore, if the attack lasts longer than 5 minutes, the emergency doctor can give an injection of such a medicine. nine0003
For antipyretics, children can be given ibuprofen 10 mg/kg every 8 hours or paracetamol 15 mg/kg every 6 hours. Do not give children aspirin!

Probability of recurrence of febrile seizures

After the first simple febrile seizure in life, recurrent seizures occur in ⅓ of children. A second attack usually occurs within 2 years after the first.

The likelihood of a recurrence of a febrile seizure is higher if:

the first seizure was before the age of 15 months; nine0008
the attack occurred at a temperature less than 38 ⁰C;

parents, brother or sister also had febrile convulsions;

the child goes to kindergarten.

Important to know

Parents often mistake febrile seizures for normal fever-related chills. With such a chill, the child's hands and feet may tremble rhythmically. It is similar to convulsions, but the child is conscious and responds if spoken to. So that the doctor can better understand whether the incident was convulsions, and if so, which ones, try to clearly fix the duration of the attack, describe it as specifically as possible, and ideally, record what is happening on video (one person helps the child, the second shoots on the phone). nine0003
Author:

Dmitrieva Olga Borisovna
pediatric neurologist

Convulsive syndrome in children - causes of convulsions, symptoms, methods of prevention

Convulsive syndrome is a non-specific reaction of the child's body to external and internal stimuli, characterized by sudden attacks of involuntary muscle contractions. The smaller the child, the more convulsive readiness he has. This is due to the immaturity of some structures of the brain and nerve fibers, the high degree of permeability of the blood-brain barrier and the tendency to generalize any processes, as well as some other reasons. nine0003
Reasons

All causes of seizures can be divided into epileptic (epilepsy) and non-epileptic.

Non-epileptic:

Spasmophilia.

Overheating.

Encephalitis, meningitis, trauma and brain infections.

Toxoplasmosis.

Metabolic disorders, primarily potassium and calcium metabolism, for one reason or another.

For newborns - hemolytic disease, congenital lesions of the nervous system, asphyxia. nine0008
Various hormonal disorders.

In acute infectious diseases, especially with a rise in temperature to febrile figures.

Intoxication and poisoning.

Hereditary metabolic diseases.

Pathologies of the cardiovascular and hematopoietic systems.

Symptoms

Tonic convulsions (spasm-muscle tension).

Pose with the upper limbs bent at all joints, the lower limbs extended and the head thrown back. nine0008
Respiration and pulse are slow. Contact with the outside world is lost or significantly weakened.

Clonic convulsions (involuntary muscle twitching).

The diagnosis of convulsive syndrome in children is made on the basis of the clinic, which in most cases does not cause difficulties. After making this diagnosis, it is necessary to clarify the nature of the convulsive syndrome, for which the anamnesis of the life and illness of the child, x-ray examination of the skull, echoencephalography, electroencephalography, angiography and other methods can be used. Laboratory tests can be quite revealing. nine0003
Prevention

Febrile convulsions (at high body temperature, above 38 C) usually stop with age. To prevent their recurrence, severe hyperthermia should not be allowed if an infectious disease occurs in a child. The risk of transformation of febrile seizures into epileptic seizures is 2-10%.

In other cases, the prevention of convulsive syndrome in children includes the prevention of perinatal pathology of the fetus, the treatment of the underlying disease, and observation by children's specialists. If the convulsive syndrome in children does not disappear after the cessation of the underlying disease, it can be assumed that the child has developed epilepsy. nine0003
More about pediatric neurology at the YugMed clinic

By leaving your personal data, you give your voluntary consent to the processing of your personal data. Personal data refers to any information relating to you as a subject of personal data (name, date of birth, city of residence, address, contact phone number, email address, occupation, etc.). Your consent extends to the implementation by the Limited Liability Company Research and Production Association "Volgograd Center for Disease Prevention "YugMed" of any actions in relation to your personal data that may be necessary for the collection, systematization, storage, clarification (updating, changing), processing (for example, sending letters or making calls), etc.
Learn more

Other signs of pregnancy early

How to stop your child grinding teeth

How often should you feel baby move at 36 weeks

How to test your child for gifted and talented

How young can a child be left home alone

How to not get morning sickness

How much money do you have to pay for child support

How to help child with divorce

How many calories should a child eat for lunch

Can you give a 4 month old water

Delivery of large baby