This factsheet gives some practical guidance on how to recognise and deal with different kinds of fits in young children.

As many as 1 in every 20 children will have some kind of fit or convulsion in early childhood. Most are brief and easily handled. The types of fits in children can 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 is not excluded or isolated from the activities of his/her peer group.

how to recognise different types of fits

Epilepsy

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

The type of seizure a child has depends on where in the brain there is a burst of abnormal electrical activity. If the whole brain is affected, the child will have a generalised seizure. There are several different kinds of generalised seizures which may look very different. An ‘absence’ involves a momentary loss of awareness when the child may stare blankly and there may be rhythmical movements of the head, hands or limbs. A ‘tonic clonic’ seizure, however, is what most people associate with epilepsy. All the muscles in the body become tense and the child becomes stiff. Breathing may stop briefly (for approximately 20 – 30 seconds) and then the body will start to jerk. The child will become unconscious and may also wet or soil himself/herself. Usually you can do nothing to stop the seizure once it has begun, except make the child safe until the convulsions have passed. Once they have ceased, turn the child onto his/her side to aid breathing and recovery.

Sometimes only part of the brain is affected and a partial seizure will occur. These vary, depending on which part of the brain is involved. A ‘complex partial seizure’ will involve some loss of consciousness and the person may seem dazed and confused. Purposeless behaviour such as random walking, mumbling, head turning or pulling at clothes may also occur. Someone experiencing a ‘simple partial seizure’ may experience a variety of strange sensations (e.g. a sense of fear, stomach discomfort, sudden jerky movements) but there will be no loss of awareness.

In most cases, you need do nothing, but make sure the child is safe during the seizure and provide reassurance once it is over.

Febrile Convulsions

If a fit occurs as a result of a high temperature in a young child, it is known as a ‘febrile convulsion’. In such cases, it is vital to reduce the child’s temperature by removing clothing and sponging with tepid water. Half 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 4.

Faints

Fits and faints are often confused. There is usually an easily identifiable reason for a child fainting – often the result of standing too long. There is usually 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 most cases of fainting, there is no movement of the arms and legs, no tongue biting and no wetting, but there can be some jerking movements. Faints are caused by a temporary reduction in the blood flow to the brain. The child should be put in a chair with his/her head between the knees or on the floor with his/her legs raised above head level.

If a child faints, loosen all clothing around the neck, chest and waist to assist circulation and breathing. Make sure the child has plenty of fresh air, then gently raise the child to a sitting position during recovery and offer reassurance.

Breath-holding Attacks

The frustrated infant (usually between the age of 1 – 2 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 the lack of oxygen, becomes limp and falls unconscious. There may sometimes be occasional jerks or stiffening of the body. The child will recover quickly and continue 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 will generally happen in the presence of an audience. The fit may be dramatic because it is staged to appeal for sympathy. The fit may involve temporary loss of behavioural control with dramatic shouting and screaming and possibly flailing of arms and legs, rolling on the ground, and tearing at clothing and hair. Hysterical hyperventilation (over-breathing) may follow and the child may be unable to move or may walk strangely. Children rarely harm 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 gentle, but firm reassurance.

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 will not generally be necessary if the fit follows the usual course.

Although alarming to witness a seizure in a child, the experience should not be blown out 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 (if the seizure continues for more than 5 minutes).