Seizures In Babies: What You Need To Know

It can be distressing to witness a baby having a seizure. Understanding the potential cause of seizures in babies, what to do when a baby is having a seizure, and when to seek emergency care can significantly improve a baby's outcome after a seizure. 

Babies' seizures can differ from those experienced by older children and adults. 

What are seizures?

Seizures result from sudden and uncontrolled electrical disturbances in the brain's nerve cells. Most people connect seizures with shaking and convulsive movements. 

Babies, especially neonates (newborns under four weeks old), have undeveloped brains. They are more likely to experience these electrical disturbances and have seizures. 

Between one and five¹ per 1,000 neonatal babies experience seizures. 

What causes seizures in babies?

Various factors can cause seizures in babies. Sometimes, no reasonable cause can be found.

The potential causes of seizures in babies include: 

• Abnormal brain development or a brain injury while in the womb, during labor, or during delivery

• Metabolic problems that cause low levels of sugar, calcium, magnesium, or sodium in the blood

• Viral illnesses and infections that affect the brain, such as encephalitis or meningitis caused by strep throat

• Bleeding in the brain (intracranial hemorrhage)

• Vitamin B6 (pyridoxine) deficiency

• Neurological disorders, such as epilepsy

• High fever, which causes febrile seizures or convulsions

• Lack of oxygen in the brain (hypoxia)

• When a blood clot blocks a blood vessel in the brain

• Genetic disorders that cause enzyme deficiencies 

Babies born prematurely or with low birth weight are more likely to have seizures in their first few weeks. These babies are at greater risk of brain hemorrhages and infections than full-term babies. 

What are the signs of a baby seizure? 

Some of the common signs that a baby could be having a seizure include:

• Staring

• Jerking movements in the limbs or having uncontrolled muscle spasms

• A stiff body

• Losing consciousness

• Having difficulty breathing

• Appearing confused

• Rapidly blinking eyes

• Drooling at the mouth

• Vomiting

• Loss of bladder and bowel control

It can be more challenging to spot seizures in preterm babies. However, they can usually be detected with an electroencephalogram (EEG). An EEG is a test that measures the electrical activity in the brain. 

Seizures can be either focal (also known as partial), meaning it originates in one area or one side of the brain, or generalized, where all areas of the brain are affected by uncontrolled electrical activity.

In children, EEG studies also show another group called multifocal seizures, where three or more distinct areas of the brain and both sides of the brain are involved. Sometimes a seizure starts as focal and progresses to a generalized seizure.

Babies can have several kinds of seizures, all of which have slightly different characteristics. They include: 

Subtle seizures

Subtle seizures most commonly occur in preterm and full-term newborn babies. They can be hard to identify because the signs of subtle seizures often include normal behaviors.

Subtle seizures are characterized by changes to breathing patterns, rapid eyelid movement, upper lip movements, pedaling movements of the arms and legs, stiff limbs, and brief jerking movements. Subtle seizures can also involve chewing, swallowing, sucking, or other repetitive tongue movements. 

Clonic seizure

Clonic seizures can occur in both newborn babies and older infants. They are more common in term babies.

These seizures often involve rhythmic jerking movements and stiffening of the limbs, face, or trunk. They can be focal, involving only one body part, or multifocal, with multiple body parts involved, which can occur synchronously or asynchronously. Usually, consciousness is preserved. 

Tonic seizures

Tonic seizures are more common in preterm babies. In a tonic seizure, a limb might become stiff and awkwardly postured, the infant's whole body may stiffen, and the eyes and head may turn to one side. The muscles usually contract for a long time. 

Myoclonic seizures

Myoclonic seizures occur in newborn babies and older infants and are not as common as the other types of seizures. It is often seen in babies withdrawing from opiates in drug-dependent mothers.

During a myoclonic seizure, the upper body may jerk forward, or the legs may jerk upward towards the stomach. These movements are often described as lightning-like and can either be isolated or repetitive, but not rhythmic. 

Infantile spasm

Infantile spasms occur in infants under 12 months. They usually occur when the baby is falling asleep or waking up.

Infantile spasms are a type of epileptic disorder that causes rapid spasms of the arms and legs. These spasms typically last from one to two seconds and may occur in clusters. 

Febrile seizures

Febrile seizures occur in young children, most often those between six months and six years old. They are the most common type of seizure in children and tend to occur in families. They’re caused by a high fever of over 100.4 degrees Fahrenheit (38 degrees Celsius).

A viral infection usually causes a fever. 

Febrile seizures are harmless. However, having one febrile seizure increases the risk of having another one. Additionally, 1–2%² of children develop epilepsy after febrile seizures. In some children, especially those with multiple or prolonged febrile seizures, the risk of developing epilepsy increases to 10%. 

Treating seizures in babies

When a baby has a seizure, seeking medical attention is important to prevent brain injury and determine what caused it.

This should involve seeing the baby’s pediatrician, followed by a neurologist (a doctor who specializes in diseases of the brain, nerves, and spinal cord).

Medications 

Sometimes, anticonvulsant medications can be used to treat seizures in babies. Anticonvulsants reduce hyperactivity in the brain. 

Anticonvulsant medications used for babies include:

• Phenobarbital, which is the most common choice for infants and toddlers

• Fosphenytoin

• Levetiracetam

• Lidocaine

• Midazolam

Other types of treatment 

In some cases, other therapies and treatments may be recommended, such as: 

Keto diet

This is a high-fat, low-carbohydrate diet under the strict guidance of a pediatrician or neurologist.

Vagus nerve stimulation

To stimulate the vagus nerve, a device sends small, regular electrical impulses to the brain stem through the vagus nerve, which runs from the brain to the abdomen.

Therapeutic hypothermia 

This therapy cools the baby’s body below the normal temperature. It can prevent or reduce brain damage caused by a lack of oxygen. 

Febrile seizures usually don’t require treatment with anti-seizure medications. Pain-relief medications such as paracetamol and ibuprofen help to bring down the fever that causes seizures. Although febrile seizures are usually harmless, it’s still important to see a healthcare professional to determine the best treatment.

Is it epilepsy?

Epilepsy is a neurological condition diagnosed when someone has two or more unprovoked seizures. Among children, epilepsy is most commonly diagnosed during infancy. 

Just because a baby has seizures doesn’t mean they have epilepsy or will go on to develop it. Sometimes, seizures in newborns just happen. But it’s important to visit your baby’s pediatrician to find out if something did happen to trigger the seizure. 

What to do if a baby has a seizure

It’s essential to stay calm and keep a baby safe during a seizure to prevent them from becoming injured. You should:

• Place the baby on a soft, protected surface like a carpeted floor (if inside) or the ground (if outside). A pillow can help to protect their head.

• Lay the baby on their side to prevent them from choking on their saliva.

• Never place anything in their mouth or try to restrain them—doing so could injure you and the baby.

• Gently clean the saliva or vomit from their mouth using a soft cloth.

• Move nearby objects out of the way.

• Loosen any tight clothing around their face and neck.

• Stay with them throughout the entire seizure and afterward.

• Time the length of the seizure and make notes about what happened.

• Make sure they keep breathing.

You should seek emergency care³ (call 911) if:

• The seizure hasn’t stopped within five minutes, or if they have multiple seizures in a short time; a seizure usually only lasts a few minutes

• The baby stops breathing

• The baby has blue lips, tongue, or face

• The baby doesn’t wake up, respond, recover quickly/gain consciousness a few minutes after the seizure ends

• The baby fell or hit its head during the seizure

• Do you have any other concerns about the baby

• It’s their first seizure, or you are unsure of its cause 

If the baby has a history of febrile or other types of seizures, they may be able to be managed at home (with the approval of a doctor). In these cases, you should still contact the baby’s pediatrician even if they haven’t needed emergency care. 

The lowdown

Seeing a baby have a seizure can be scary and distressing. However, most babies recover well after having a seizure and can live normal lives. Following the correct safety advice and seeking medical attention quickly is essential. Predicting a seizure can be difficult, so knowing what to do can save time. 

Frequently asked questions

Below are some of the frequently asked questions about seizures in babies. 

Are seizures in babies normal?

Seizures in babies are relatively common, but they aren’t normal. A seizure occurs when regular electrical activity in the brain is disturbed.

Do baby seizures go away?

It depends on why the baby is having seizures. For instance, febrile seizures are usually a one-time occurrence. However, having more than one febrile seizure increases the risk of developing epilepsy, a lifelong neurological condition characterized by recurrent seizures. 

Do infant seizures cause brain damage?

Seizures shorter than five minutes don’t usually cause brain damage unless the infant hits their head during the seizure. If the seizure lasts longer than five minutes, oxygen flow to the brain can be affected, which can cause brain damage.