FITS IN THE UNDER FIVES

by Epilepsy Association of Scotland

Guidelines for people working with this age group

Fits are quite common in young children for a variety of reasons. Most fits are brief and easily handled, and should not cause those who work with the under fives to feel greatly anxious about dealing with them. As many as one in every twenty children will have some kind of fit or convulsion in early childhood.

The types of fits that children may have include epileptic seizures, febrile convulsions, faints, breath holding attacks, and hysterical fits. All of these attacks can involve real or apparent loss of consciousness.

Fits are very rarely an adequate reason for excluding a youngster from normal everyday activities. It is important at this age that a child should not be excluded or feel isolated from the activities of his/her peer group.

Types of fit
Epilepsy

Of the 5% of all infants who have a fit or convulsion, very few have a recurring tendency to have seizures. Those who do are said to have epilepsy.

The type of seizure a child has depends on the location in the brain of the burst of abnormal electrical activity that triggers the seizure. If the whole brain is affected, the child has a generalised tonic clonic seizure. This is the kind of seizure most people think of when they hear the word "epilepsy". All the muscles in the body become tense and. the child goes stiff. Breathing may also stop briefly (approximately 20-30 seconds) and then the body starts to jerk, sometimes quite violently. The child becomes unconscious, and may also wet or soil himself/herself. Usually you can do nothing to stop the seizure once it has started, except to make the child safe until the convulsions pass. Once the convulsions have ceased, turn the child on to his/her side to aid breathing and help recovery.

Sometimes only part of the brain is affected by abnormal electrical activity, and the seizures may look very different. "Absences" (brief blank spells) may occur, sometimes accompanied by rhythmic movement of the head, hands, or limbs.

Sometimes the seizure may take the form of jerking in different parts of the body without loss of consciousness. In other instances, if the excess electrical activity occurs in the part of the brain controlling feelings or emotions, odd behaviour can result. In most cases you need do nothing but make sure the child is safe during the seizure, and gently reassure the child once the seizure is over. For further information, see "How best to help".

Febrile convulsions

If a fit occurs as a result of a high temperature in a young child, then this is called a febrile convulsion. In such a case it is vitally important to reduce the child's temperature by removing clothing, sponging the child with tepid water, and using a fan if possible. Half of the children who have febrile convulsions will have a second one given the same situation, but few will develop established epilepsy. Febrile convulsions are rare after the age of four (for further information, see "Febrile convulsions - Advice for parents").

Faints

Fits and faints are often confused. However there is usually an easily identifiable reason for a child fainting. It is often the result of standing too long. There is a warning sensation of light headedness, sickness, and weakness of the legs, whereas there is not always a warning when an epileptic seizure occurs. In almost all cases of fainting there is no movement of the arms and legs, no tongue biting, and no wetting.

Faints are caused by a temporary reduction in the flow of blood to the brain, hence the correct first aid procedure is either to put the child in a chair with his/her head between the knees, or to lay the child on the floor with the legs raised above head level. If the child does faint, then loosen all clothing around the neck, chest, and waist, to assist circulation and breathing. Make sure the child has plenty of fresh air, gently raise the child to a sitting position during recovery, and offer reassurance.

Breath Holding Attacks

The frustrated infant (usually between the ages of one and two years) may hold his/her breath after a spell of crying. Some children may cry vigorously and involuntarily catch their breath. After a few seconds the child turns blue because of lack of oxygen, falls limp, and is unconscious. There may sometimes be occasional jerks or stiffening of the body. The child recovers quickly and continues as if nothing has happened. Such attacks cannot be prevented but will disappear as the child grows older.

Hysteria

These fits usually occur as an over-reaction to an emotional upset or nervous stress, and generally happen in the presence of an audience. The fit may be dramatic, because it is staged to appeal for sympathy to whoever is present. The fit may involve temporary loss of behavioural control, with dramatic shouting and screaming, and possibly vigorous flailing of arms and legs, rolling on the ground, tearing at clothes and hair. Hysterical hyperventilation (over-breathing) may follow, and the child may be unable to move, or may walk strangely. Rarely do children do anything to cause harm to themselves during such a fit.

The way to manage hysterical fits is to refrain from showing any sympathy, isolate the child from any onlookers, and help the child to calm down by gently but firmly reassuring them. Do not physically restrain or slap the child. As soon as possible, give the child something to do and unobtrusively monitor subsequent behaviour.

Conclusion

In the event of a first fit, it is advisable to seek medical advice to determine the cause. A doctor may also suggest precautions and possibly prescribe medication. If subsequent fits occur over a period of time, medical help is not generally necessary if the fit follows the usual course.

Although it is very alarming to witness a seizure in a child, it is important to retain a sense of proportion. Children are quick to sense an atmosphere, and will be aware of the anxiety they have caused.

Simple precautions can be taken to reduce the risks during seizures, but excessive restrictions should be avoided. In the long term, overprotection can damage the child more than the occasional seizure will.

Medical help should always be sought quickly for prolonged convulsions and seizures.