Seizures, Febrile Convulsions & Meningitis

Febrile seizures most commonly occur in children of which age range?

• ABirth to 6 months
• B3 months to 3 years
• C6 months to 6 years✓
• D6 years to 12 years

Answer: NHS guidance says febrile seizures are linked to a high temperature and usually happen between 6 months and 6 years of age. Newborns under 6 months and children over 6 years rarely have them, and a 3-month-to-3-year band is not the range the NHS gives.

How long does a typical febrile seizure last?

• A20 to 30 minutes
• B5 to 10 minutes
• C10 to 15 minutes
• D2 to 3 minutes✓

Answer: Most febrile seizures stop on their own within 2 to 3 minutes, and the NHS says it is rare for one to go beyond 10 minutes. The longer ranges describe a prolonged seizure that needs emergency help rather than a typical episode.

A feverish 18-month-old at nursery suddenly stiffens and starts jerking. What should the first aider do?

• ALay the child flat, tilt the head back and start five rescue breaths
• BHold the child still, keep the mouth open with a spoon and sponge them with cold water
• CTime the seizure, protect the head with something soft and move objects away✓
• DPick the child up, carry them to the office and run cold water over them

Answer: During a febrile seizure you note the start time, cushion the head, clear the area and stay with the child until it stops. Restraining, putting anything in the mouth, moving the child or trying to cool them with cold water are all things the NHS says not to do, and rescue breaths are only for a child who is not breathing normally.

While a child is having a febrile seizure, which action does NHS guidance specifically warn against?

• APlacing something soft under the head to protect it from knocking the floor
• BNoting the exact time the seizure started and the time at which it finished
• CUndressing them or sponging them with cold water to bring the temperature down✓
• DMoving hard or sharp objects out of the way of the child's flailing arms and legs

Answer: The NHS says not to try to cool a child who is fitting by undressing or sponging them with cold water, and not to hold them still or put anything in their mouth. Timing the seizure, cushioning the head and clearing the surroundings are exactly the actions it recommends.

A child's febrile seizure has just stopped and they are breathing but drowsy. What should the first aider do next?

• AWrap the child in a blanket and lay them flat on their back to rest
• BPlace the child in the recovery position and check nothing is in the mouth✓
• CGive a dose of paracetamol immediately and put the child down for a nap
• DSit the child upright and give them a cool drink to help bring the fever down

Answer: Once the seizure has finished the child goes into the recovery position so the airway stays clear, and you check that nothing is in the mouth. A drowsy child who has just fitted is not safe to swallow drinks or medicine, and laying them flat on their back leaves the airway unprotected if they vomit.

A two-year-old with no history of seizures has a 90-second febrile seizure that stops on its own. What should the setting do?

• ACall 999, because every first febrile seizure needs hospital assessment✓
• BRing the parents to collect the child, because a GP appointment can wait until tomorrow
• CCall NHS 111 for advice, because only seizures over 5 minutes are emergencies
• DRecord it in the accident book, because a seizure under 2 minutes needs no follow-up

Answer: The NHS lists a first seizure among the reasons to call 999, and every child having their first febrile seizure needs assessment in hospital. A short seizure is not a reason to skip that, waiting for a GP the next day delays it, and NHS 111 is not the route when the guidance says 999.

Which of these features of a febrile seizure means 999 should be called?

• ATwitching that affects only one side of the body✓
• BDrowsiness lasting about 20 minutes afterwards
• CThe child wetting themselves during the seizure
• DBriefly losing consciousness while the seizure is happening

Answer: One-sided twitching is one of the NHS red flags for calling 999, alongside a first seizure, a seizure lasting over 5 minutes, breathing difficulty, more than one seizure in 24 hours and unusual sleepiness for over an hour afterwards. Briefly losing consciousness and wetting themselves are ordinary features of a febrile seizure, and drowsiness for up to an hour afterwards is expected.

A febrile seizure has been going on for some time. At what duration does NHS guidance say to call 999?

• AMore than 1 minute
• BMore than 5 minutes✓
• CMore than 10 minutes
• DMore than 15 minutes

Answer: The NHS says to call 999 if a febrile seizure lasts more than 5 minutes, even though most stop well before that. Calling at 1 minute would be before a typical seizure has even finished, and waiting for 10 or 15 minutes delays emergency care for a prolonged seizure.

A child with diagnosed epilepsy has a seizure at nursery. Which protective steps apply?

• AThe same steps as for choking: five back blows, then five chest thrusts, repeated as needed
• BDifferent steps from a febrile seizure: hold the arms still, then the legs, until the jerking stops
• CDifferent steps from a febrile seizure: place a folded cloth between the teeth, protecting the tongue
• DThe same steps as for any seizure: time it, cushion the head and clear the space✓

Answer: Whether a seizure comes from a fever or from known epilepsy, the first aider protects the child in the same way: time it, protect the head, remove hazards and use the recovery position afterwards. Restraint and objects in the mouth are dangerous in any seizure, and the choking sequence has nothing to do with a fit. Staff also follow the child's individual healthcare plan for any emergency medicine and its 999 trigger.

Which sign in a baby should make a first aider think of meningitis?

• AA runny nose with clear watery discharge
• BA mild nappy rash that fades with cream
• CDribbling much more than usual while cutting a tooth
• DA bulging soft spot on the top of the head✓

Answer: A bulging fontanelle is one of the meningitis signs the NHS lists for babies, together with refusing feeds, a high-pitched unusual cry and being stiff or floppy. A runny nose, teething dribble and nappy rash are everyday findings that do not point to meningitis.

A first aider presses a clear glass against a rash on a feverish child with dark brown skin and cannot tell whether it fades. What does NHS guidance advise?

• ACheck the palms, soles and inside the eyelids, and call 999 rather than waiting for a clear result✓
• BPhotograph the rash, send it to the parents and ask them to take the child to a GP
• CRepeat the glass test every 10 minutes, until the result becomes clear, before deciding whether to call
• DApply a cold compress to the rash for 15 minutes, then check whether it has changed colour

Answer: The non-fading rash is harder to see on brown or black skin, so the NHS says to look at the palms, soles and inside the eyelids, and not to wait for a rash before calling 999. Repeating the test, photographing the rash for parents or applying a compress all delay emergency care for a child who may have meningitis.

A feverish four-year-old has cold hands and feet, a stiff neck and is turning away from the light, but has no rash. What should the first aider do?

• AGive paracetamol and re-check in an hour, because the fever is the main concern
• BCall 999 now, because not every child with meningitis develops a rash✓
• CWatch for a rash to appear, because that is the sign that confirms meningitis
• DRing NHS 111, because a rash-free child does not meet the criteria for 999

Answer: Fever with cold extremities, neck stiffness and dislike of light is a meningitis picture in itself, and the NHS is clear that you do not wait for a rash before calling 999. Treating the fever and reviewing later, or downgrading to NHS 111, risks a fatal delay.