Andrew McIntosh, MD | All Rights Reserved © 2019

Staring Spells

While staring spells and daydreaming are common for children, there could be an underlying cause, including absence or focal-onset seizures. Learn how to differentiate seizures from inattention and daydreaming.

What is the differential of staring spells?

Staring events in children are often simply inattention or daydreaming, where the child will “zone out” for a brief period of time (seconds up to minutes). Frequently, children are engaged in other activities and will not respond to parents or teachers, creating concern. Similarly, more worrisome absence and focal onset seizures can present as isolated staring as well.

How can a parent differentiate seizures from inattention or daydreaming?

First, we try to determine if the child is truly unresponsive. Parents often try to get their child's attention when they stare by calling the child's name or waving their hands in front of them. However, to truly gauge response, we recommend that parents engage their child with more vigorous stimulation such as a gentle shake on the shoulder or touch on the cheek. If the child still does not respond to tactile stimulation, then the next question to ask is whether the staring is associated with an abrupt pause of activity, as this is more concerning for seizures. Finally, ask if there are any associated signs, such as rhythmic eyebrow movement, blinking, eye rolling or eye deviation which may also be suggestive of seizures.

If there is concern for seizure, how do you differentiate absence seizures from focal seizures?

Absence seizures are typically brief events (5-15 seconds) of sudden pause during activities or during conversation followed by the child resuming their normal activity without a post-ictal period. Focal seizures more commonly last 30 seconds or longer and can be associated with a post-ictal period of sleepiness or similar symptoms. Absence seizures often occur numerous times in a day, whereas focal seizures may be more sporadic.

What is the initial workup if the events sound like seizures?

A routine outpatient EEG is valuable first test in the evaluation of staring spells. The study often helps diagnose absence seizures because during hyperventilation, the EEG often shows very specific generalized abnormalities. Routine EEG testing is less sensitive for focal seizures; however, localized abnormalities may be seen. If the diagnosis remains in doubt, more prolonged ambulatory (at home) or inpatient EEG monitoring may be necessary.

When should a child be referred to a neurologist?

Any child with spells clinically suspicious for seizures or abnormal EEG testing should be referred to a neurologist for further evaluation and treatment.

Dr. McIntosh is Board-Certified in Neurology with Special Qualification in Child Neurology.  He has received extensive training and experience starting back in 2002 with General Pediatrics, Adult Neurology and Child Neurology Residencies at the University of California, Irvine.  He subsequently built a successful private practice in Laguna Niguel.  He is frequently called upon to lead educational programs and serves in several medical advisory roles. Over the years, he established himself as a dedicated physician leader passionate for improving the well-being of Southern California families. He is a member of the Medical Staff at Children's Hospital of Orange County.