There are around 10,000 children with epilepsy aged five years and under in the UK. Epilepsy Action explains what early years practitioners need to know…
If a child has epilepsy, it means they have a tendency to have seizures. A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption in the normal message passing between brain cells. This disruption results in the brain’s messages becoming halted or mixed up. The brain is responsible for all the functions of the body, so what a child experiences during a seizure will depend on where in the brain the epileptic activity begins and how widely and rapidly it spreads. For this reason, there are many different types of seizure and each child will experience epilepsy in a way that is unique to them.
There are several different kinds of seizures, and a child may experience more than one type. The child’s parents will be able to tell you about their child’s seizures and the signs and symptoms to look out for.
The type of seizure that many people picture when they think of epilepsy are tonic-clonic seizures. An affected child will go stiff, lose consciousness, fall to the floor and begin to jerk or convulse. They make look a little blue around the mouth from irregular breathing. Tonic-clonic seizures can last for a few minutes. Remember ACTION for tonic-clonic seizures:
A= Assess: Assess the situation – are they in danger of injuring themselves? Remove any nearby objects that could cause injury.
C= Cushion: Cushion their head (with a jumper, for example) to protect them from head injury.
T= Time: Check the time – if the seizure lasts longer than five minutes you should call an ambulance.
I= Identity: Look for a medical bracelet or ID card – it may give you information about the child’s seizures and what to do.
O= Over: Once the seizure is over, put them in the recovery position. Stay with them and reassure them as they come round.
N= Never: Never restrain the child, put something in their mouth or try to give them food or drink.
Call an ambulance if:
● You know it is a child’s first seizure.
● The seizure lasts for more than five minutes.
● One seizure appears to follow another without the child gaining consciousness in between.
● The child is injured.
● You believe the child needs urgent medical attention.
Another kind of seizure is a focal seizure (also known as a partial seizure). During such seizures, the child may remain alert or they may not be aware of what is happening. There are many signs that a child could be having a focal seizure such as unusual body movements, repeatedly chewing, swallowing, fumbling with their buttons, screaming or crying out. They may not be able to speak or understand what is being said, and they may wander off without knowing where they are going or what they are doing. If a child has a focal seizure, stay with them, guide them away from dangers (such as obstacles) and stay with them until they come round.
Absence seizures are where a child appears to be daydreaming or switching off for a few seconds.
The majority of children with epilepsy take epilepsy medicines to control their seizures. These medicines are usually taken twice a day, at home. This means there should be no issues about storing or administering medicines in nursery time. Certain types of medicines taken for epilepsy can have an effect on a child’s learning or behaviour. It is important staff are aware of this. If staff notice a change in the child’s learning or behaviour, they should discuss this with their parents.
The only time medicine may be urgently needed by a child with epilepsy is when their seizures fail to stop after the usual time or the child goes into status epilepticus. Status epilepticus is defined as a prolonged seizure or a series of seizures without regaining consciousness in between. This is a medical emergency and is potentially life-threatening. If this happens, the child may have been prescribed emergency medicine. This needs to be administered by a trained member of staff. If this isn’t possible an ambulance should be called. For more information on emergency medicine and training, visit epilepsy.org.uk/emergencytreatment
There are some simple things that early years settings can do to support children with epilepsy.
An epilepsy policy ensures children with epilepsy are supported appropriately. The policy should include information about how to assess a child for support to achieve their full potential, what training staff have or will be attending, how to write an individual healthcare plan (see below) and what other things the nursery can do to raise awareness.
An Individual Healthcare Plan (IHP)
All children with epilepsy should have an Individual Healthcare Plan (IHP), even if their seizures are well controlled. Everyone should be involved in writing the IHP, including the setting and parents or carer. An epilepsy specialist nurse should also be involved.
Establish good communication channels
Communication between all parties including the nursery and parents is vital. Speak to parents about their child’s epilepsy so you can understand the condition and recognise the signs and symptoms of their seizures.
Training for practitioners will make sure they feel equipped to support children with epilepsy. This could be either general epilepsy awareness to understand what epilepsy is, or the administration of medication for an emergency situation.
Four-year-old Andrew McMorris was diagnosed with epilepsy when he was two years and eight months. His parents were very concerned as he was preparing to go to nursery soon after. They were unsure of whether he would cope with attending nursery.
The family approached Lisnagelvin Nursery School. They met with the principal at the nursery before Andrew started and a plan was put in place. Staff at the nursery have received extensive and ongoing epilepsy training. He has an individual healthcare plan and the nursery has a medical policy. Andrew takes part in all activities and aspects of nursery life.
Andrew’s parents were very keen that Andrew should be treated the same as all other children at the nursery. The nursery staff have really embraced this. Communication between the nursery and Andrew’s family has been strong, before and since he joined the nursery. His parents are confident to leave him in the care of the nursery and they can be free from worry while he is there.
For more information about epilepsy and children, and to download education resources, visit Epilepsy Action’s website or call the Epilepsy Helpline freephone 0808 800 5050.