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An electroencephalogram, commonly called brain wave testing in children, records the electrical activity of brain cells through small electrodes attached to the scalp. The test sends no current into the child's head, a widespread myth that frightens families for no reason, and it uses neither radiation nor needles; all the child feels is the gel and the touch of the electrodes. The machine only listens and draws the waves of electrical activity for analysis. It is usually requested after a seizure to classify the event and decide whether it represents epilepsy, for absence or staring episodes that resemble inattention, for unexplained repetitive movements, for recurrent jerks or muscle twitching, for unusual sleep disturbances, for regression of skills a child had already mastered, and to follow the response of epilepsy to treatment before any change is decided. Several formats exist: a short awake recording, a study that includes sleep, and prolonged video monitoring over hours that links visible movement to the electrical trace. The test has limits that parents deserve to know. A normal recording does not exclude epilepsy, because it captures only a short window of time that may contain no abnormality; conversely, atypical waves alone do not mean a child has epilepsy, since the diagnosis is primarily clinical and rests on how the event looked and evolved. For this reason a phone video of the episode may be more valuable than the test itself. An electroencephalogram also does not measure intelligence, does not diagnose autism or attention deficit hyperactivity disorder, and does not replace magnetic resonance imaging, which shows the structure of the brain. There is also what to do during the seizure itself: turn the child onto their side, move hard objects away, place something soft under the head, and time the event from its start. **Never put anything in the child's mouth during a seizure, not a spoon, a finger or water; this is a myth that causes injuries, broken teeth and blocked breathing**, and do not try to restrain the movements by force. **Call an ambulance immediately if the seizure lasts more than five minutes, if it repeats twice or more without the child regaining consciousness in between, if this is the first seizure of the child's life, if it comes with fever and a stiff neck or a skin rash, if it follows a head injury, if it is accompanied by breathing difficulty or blue discolouration, or if the child does not regain consciousness afterwards.** Which type of recording is appropriate, and how its findings should be interpreted, are decided by clinical assessment with a paediatric neurologist, and the waves are never read in isolation from the child's story.
The child is told that the machine only listens to the brain, will not hurt and will not deliver any electricity. Hair should be clean and dry with no oils or gel, and any laboratory instruction to shorten the child's sleep the night before is followed when sleep during the recording is required.
The head circumference is measured and standard positions are marked, then small electrodes are attached with conductive gel or paste, sometimes using an electrode cap. The process needs patience and works best with the child on a parent's lap, distracted by a toy, a story or a screen.
Electrical activity is recorded while the child rests quietly with eyes closed, and sleep is then encouraged if a sleep recording is needed, because many abnormalities appear only during sleep. Lights are dimmed and noise reduced, and parents are asked to sit quietly without moving the child.
Safe manoeuvres are used to reveal abnormalities that a quiet recording may miss: opening and closing the eyes, a few minutes of fast deep breathing in cooperative children, and intermittent photic stimulation. Any manoeuvre is stopped at once if it distresses the child.
A specialist reads the whole recording, describes the wave pattern and the location of any abnormality, then correlates it with the description and video of the event, the neurological examination and the child's development. A plan follows: reassurance and follow-up, magnetic resonance imaging, or starting or adjusting treatment.
Wash your child's hair the night before or on the morning of the test and apply no oil, cream or gel, as these prevent the electrodes from sticking. Bring a written list of all your child's medicines, and never stop an antiseizure medicine or change its timing on your own; only the doctor decides that if it is needed. If the laboratory asks you to shorten your child's sleep beforehand, follow the instruction precisely and arrange for someone to keep the child awake on the journey so they do not sleep in the car. Feed your child before the test, since fasting is not usually required unless you were told otherwise, and avoid chocolate and stimulant drinks. Bring any phone videos of the episodes, because they are extremely valuable, and write down the times and descriptions of the events. Bring a favourite toy or blanket, spare nappies and clothes, and explain in advance that the test does not hurt.
There are no restrictions afterwards: your child returns to school, food and activity immediately. Wash the hair with water and shampoo to remove the gel or paste, which may take two washes. Do not expect an instant result, because the recording is read in detail and interpreted together with the child's history and examination, so never rely on the wording of the report alone. Keep filming any episode with its start and end times and what the child did before and after, and bring this to the review. Give your child's medicines exactly as prescribed and do not stop them because the recording looked normal. Teach everyone who cares for the child how to manage a seizure: turn them on their side, time the event, and put nothing in the mouth. **Call an ambulance immediately for a seizure lasting more than five minutes, repeated seizures without regaining consciousness, a first ever seizure, a seizure with fever and a stiff neck or rash, a seizure with breathing difficulty or blue discolouration, a seizure after head injury, or new weakness on one side of the body afterwards.**
Usually 30 to 60 minutes, extending to several hours for sleep studies or prolonged video monitoring
Dr Hussain Jarawan is a consultant in pediatrics and pediatric neurology. He holds a medical degree from the University of Jordan and Jordanian Board qualificat…
Dr Saleh Fakhri Al Ajlouni is a senior consultant in pediatric neurology. His qualifications include a medical degree from the University of Peshawar, a Diploma…
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