Tonic-clonic seizures (formerly known as grand mal seizures) are the type most people imagine when they think about epilepsy, and they are a common type of seizure in children. These convulsive generalized seizures typically begin with a cry or sound caused by air being forced from the lungs, then progress to the tonic phase, which often involves a fall to the floor, stiffening of the limbs, clenching of teeth, and rolling back of the eyes. The tonic phase, which rarely lasts more than 30 seconds, is followed by the clonic phase, which presents itself as the rapid, rhythmic jerking of the limbs and torso. This phase is also characterized by shallow breathing, a bluish appearance to the skin, and loss of bladder and/or bowel control. The clonic phase typically lasts for a few minutes before it gradually begins to slow and eventually stops. After the seizure, individuals are typically difficult to rouse and, if awakened, will be sleepy and confused.