Epilepsy affects an estimated 21,000 children under the age of five in the UK, and it is likely that most childcarers during their career will care for at least one child with the condition. Epilepsy, which is the tendency to have recurrent seizures, is the second most common neurological disorder after migraine. The role of a childcarer in dealing with the condition is crucial, says Amanda Dwyer, information services officer at the charity Epilepsy Action .
'It's best for nursery staff to be calm and treat epilepsy as no big deal,'
she says. 'Staff should not create a panic, or children will worry as well.
But if they deal with it in a reassuring way the child will benefit and it will help other nursery children to develop a healthy and accepting attitude too. Unfortunately, there is still a stigma attached to epilepsy and problems tend to arise when a child is treated differently from others.
The more children know about epilepsy and accept it, the better it is.'
Epilepsy can begin at any age but often starts early in life. With a few sensible precautions, the condition does not stop most children from having a normal life - including attending mainstream nursery or school, playing games and swimming.
Many children with epilepsy have the same range of intelligence and abilities as unaffected children. But some can experience behavioural problems or learning difficulties. Aspects of epilepsy affecting this include damage to the brain, anti-epileptic medication or psychological and social factors.
Types of seizures
An epileptic seizure is caused by a brief disruption of brain function involving temporary abnormal electrical activity in the nerve cells. Where this activity occurs determines the type of seizure.
There are around 40 different types of seizure. A childcarers' ability to recognise the basic types may be vital in helping a child to receive proper treatment and fulfil their potential. If a child is suspected of having seizures, their parents should be notified immediately. Communication between practitioners, parents and doctor is essential and an accurate description of a seizure can aid diagnosis.
The most common types of seizures experienced by children are tonic clonic and absence seizures.
Tonic clonic is the seizure most people think of when imagining epilepsy.
The muscles contract, forcing air out of the lungs, sometimes causing a child to cry out, and the body stiffens (the tonic phase). After a few minutes the clonic phase begins, and the child's limbs jerk because their muscles contract and relax in quick succession. A child may bite their tongue, be unable to swallow saliva or be incontinent. They may have irregular breathing and go pale because of lack of oxygen. The muscles then relax after around a minute and their body goes limp. Recovery times may vary, but a groggy period of confusion, headache and sleep often follows.These seizures can be distressing to witness, and childcarers will need to reassure any other children who see them.
Absence seizures can look as if a child is simply daydreaming. They stare, blink, or look vague for a few seconds, before carrying on what they were doing. During an absence seizure the child is momentarily unconscious and cannot be alerted or woken up.
Understanding and a matter-of-fact approach are all that is needed from childcarers when this type of seizure occurs. They should be aware that the child will miss out on any instructions or information given during the seizure.
However, absence seizures are hard to detect and parents or carers may lose patience with a child who is having them unless it becomes apparent that something more serious is happening.
Questions for carers
Epilepsy is generally managed with anti-epileptic medication to control seizures. Around 80 per cent of children with epilepsy have no seizures or very few once the appropriate drug and dosage is established. It is essential children take the correct dosage at the right time, but in most cases medication will not need to be taken during nursery hours. The nursery must have very clear guidance on who should administer medicine and where it is kept.
Childcarers should find out as much information as possible about a child's epilepsy before they start nursery. Important questions to ask parents include:
* What type of seizures they have
* How long they last and what they look like
* How long a rest the child may need
* Any events that may trigger a seizure
* What medication is taken and when
* Whether the child has a warning (aura) before a seizure.
Further information
* Epilepsy Action Freephone helpline: 0808 800 5050 Website: www.epilepsy.org.uk
* The National Society for Epilepsy UK Epilepsy Helpline: 01494 601400 DEALING WITH A SEIZURE
Do:
* Stay calm
* Loosen any tight clothing around the child's neck
* Protect the child from injury by removing any sharp or hard objects
* Cushion their head if they fall down
* Aid breathing by placing the child in the recovery position once the seizure has finished
* Stay with a child who has had a tonic clonic seizure until they fully recover
* Be reassuring Don't:
* Try to restrain a child having a seizure
* Put anything in their mouth or between their teeth
* Try to move them unless they are in danger
* Give the child a drink before they are fully recovered Call an ambulance if:
* It is the child's first seizure
* A tonic clonic seizure lasts for more than five minutes, or one follows another without the child regaining consciousness
* The child is badly injured during a seizure
CASE STUDY: GOING TO NURSERY
Isobel Gant (3 years 10 months) had her first seizure, a suspected febrile convulsion, when she was 18 months old. 'She shook and her eyes rolled. We took her to hospital where they found she had a high temperature and urine infection,' says her mother Valerie. 'The doctor said it isn't uncommon for young children to have a one-off seizure when they are running a high temperature because the brain can't cope. We thought it was just one of those things, but a week later she had another and then another.'
Following tests, including an EEG and brain scans, Isobel was diagnosed as having epilepsy and learning difficulties when she was two-and-a-half years old. Scans show abnormalities in the temple lobe of the brain that controls communication, concentration and memory. 'We feel the special needs and epilepsy are linked, but the consultant says it's difficult to know,' says Valerie.
Isobel is thought to have severe myclonic epilepsy but is undergoing further tests to establish this. She has been prescribed two types of medication which she takes with her breakfast and evening meal. The drugs have brought her seizures under better control but she still experiences absences most days, a minor seizure every couple of weeks and a major one around every six months.
'The absences don't last long - around a few seconds - and she is not particularly disoriented afterwards. She shakes uncontrollably during a minor seizure which last about three minutes. Once they pass she often wants to sleep,' says Valerie.
Since September Isobel has attended afternoon sessions at Our Lady of Lourdes Catholic Nursery in Southport, a mainstream nursery which has additional special needs resources. She has a learning support assistant who can work one-to-one with her or allow independence, depending on her need. Nursery staff have undergone specialist training in administering rectal diazepam in the event of a major seizure, although it has not been called for. The drug is kept at nursery.
Special needs co-ordinator Helen Robinson, accompanied by a nursery teacher, made a home visit before Isobel started at the nursery to discuss how her epilepsy presents itself and is managed. There is close liaison between the nursery, Isobel's parents and her hospital paediatrician.
Procedures are reviewed regularly. 'Staff have been very helpful and are not fazed by the seizures - they reassure her and give her a cuddle,' says Valerie. 'Parents have been supportive and the nursery children are very accepting. Staff have explained the seizures to them and explained how everyone is different.'
Helen Robinson says, 'We've learned that stress can trigger a seizure, so Isobel's targets are set lower than other children's. We now know when she is starting to get agitated and can steer her on to an activity that will help calm her.
'There was one occasion when she got extremely agitated at nursery and that night she had a major seizure, so we know to report such behaviour to her parents. Information gathering and exchange is paramount. We are in regular contact with Isobel's mother and contact her if we need advice. We're now working with Isobel to prepare her for progressing to school.'