Health Awareness blog

   Febrile convulsions means episode of fits that have been preceded by high grade fever in child. The child usually aged between 6 months to 6 years. 1 in 20 children from this group of age will get affected.  

What is it mean by convulsion?   
     A convulsion is a fit where a child goes very stiff. He/she will shake of the arms and legs. (In medical term, it is described as symmetrical generalized tonic and clonic seizure without focal features) In a lot of cases, there are also up rolling eyeball and drooling saliva. It usually lasted 10 minutes or less. After the convulsion, the child might go into sleep. Some of them will pass urine or even stool.  

Causes of Febrile convulsions  

• Acute upper respiratory tract infection
• Urinary tract infection
• Gastrointestinal infection
• Meningitis
• Meningoencephalitis
• Brain lesions
• Trauma
• Hypoglycemia
• Hypocalcaemia
• hypomagnesaemia

Tretments that can be done.  

• First of all, don’t be panic
• Lay your child on his/her side
• Ask someone to call your family doctor
• Check your child temperature. If rise, strip down your child and give paracetomol to relieve the fever (either oral or suppository)
• Tepid sponging your child with lukewarm water. Cold water might rise the temperature further.
• In certain places where your doctor cannot pay you a visit, then you have to arrange for the child to be brought to hospital for further evaluation and management.
• Don’t forget that you should not put anything into your child mouth as this can cause choking.

What investigations will the doctor do?  

• Full blood count – if the total white cell count is raise, antibiotics should be started.
• BUSE – to look for electrolytes imbalance
• Blood sugar level – to look for evidence of hypoglycemia
• Throat swab – to see for any infection of the throat
• Urine FEME – to see for any sign of urinary tract infection
• Chest X ray – might be needed if pneumonia (lung infection) is suspected
• Serum calcium (Ca2+), Phosphate (PO-4) Magnesium (Mg2+)- any of these abnormality may cause fit
• Lumbar puncture – it will only be done if your child is suspected to have meningitis.
• Further investigation such as EEG is appropriate if the convulsion

How about recurrence rate?
     In 3 out of 10 children, febrile fit might recur. In this group of patient, you will be given a supply of diazepam suppositories as you leave the hospital and you will be taught how to insert the tablet.  If any further convulsions recur, you should use one of these suppositories before call up your family doctor. A reliable thermometer at home is recommended.  

Is it mean that my child have epilepsy?
     No. However the child might progress into epilepsy. Very rarely febrile convulsion will lead to epilepsy. The prevalence of epilepsy is slightly greater than other child.  Most of the time, the children will grow out of them without any ongoing problems including brain damage.     

Reference:

1. Oxford handbook of clinical specialties, 5^th edition.
2. Quick reference cards: medical Protection Society

Child health fact sheet : Children

     The term ‘eczema’ is coming from Greek, means ‘boiling’. It is a common skin condition seen by physician in out patient setting. It is describes as an acutely inflamed weeping skin with vesicles and a chronic relapsing inflammation of the skin. It usually associated with atopy (asthma, hay fever and urticaria). The patient usually presented with positive family history of atopy.

Clinical features of eczema  

• Itchy erythematous scaly patches – this is a common presentation mainly seen at flexures area as in front the elbows and ankles, around the neck or behind the knees. In infants, the lesion usually started at face
• Small vesicles – only seen in very acute lesions
• Excoriation and lichenification (skin thickening) – usually produces by repeated scratching. This may present together with exaggerated skin markings.
• Papules or follicles – seen in pigmented skin patients
• Pitting and ridging of the nails – rarely seen. Only in nail bed involvement.

What cause eczema?  
     The cause is multifactorial. It can be due to genetic cause, infection, allergen and diet. As mentioned above, a positive family history of atopy is the leading causing of eczema, hence the strong genetic component. Staph aureus colonies and staph endotoxin known organisms that acts as super antigen. This is how infection can lead to eczema. Animal dander, dust and pollens are common allergens that cause this nightmare. And it also known that a big proportion of atopy sufferer have significant food allergies, this can be varies from eggs to seafood.What are the complications?  

• Infections
• Fungal infection : candida
• Eczema herpeticum ( herpes simplex manifestation)
• Repeated scratching and excoriation lead to chronic skin scarring.
• Chronic skin depigmentation ( this often seen in pigmented skins)
• Poor performance at school is one big problem when the eczema is serious enough to keep the child from sleep at night. They will feel tired in the morning and probably fall asleep in their classes.

What about the investigations?  
     Atopic eczema usually had been diagnosed clinically from the history and the presented skin lesions. However there are some tests available such as radio-immunoabsorbent assay (RAST tests) of blood, skin prick test or peripheral blood film (to see eosinophilia). These investigations are based on the fact that high specific IgE levels will be high to certain ingested or inhaled antigens in atopy patients.  Prognosis  
     Spontaneous improvements are expected in early onset eczema to majority of children. Only some of them will still have recurrence of eczema during adult life. The late onset eczema is a bad news followed by a more chronic remitting or relapsing course.  Management at out patient setting

• Greasy emollients (e.g.: Vaseline and aqueous lotion)
• Bath oil can also be used to substitute the soap.
• Topical steroid (e.g.: 1 ‰ hydrocortisone suitable for use on the face). More potent steroids might be use in severe eczema, however it is only recommended for a short period to avoid the side effects of steroids such as skin thinning, striate and adrenal suppression.
• Appropriate antibiotics (e.g.: cloxacillin) might be use in managing the infections. We have to be careful not to abuse the usage of antibiotics to avoid resistance.
• Sedating antihistamines are useful at nighttime. Their big help probably due to the sedative properties rather than their antihistamine activity where sedation can reduce the scratching and help the patient to sleep better.
• Paste bandaging might be useful. Apart of its mechanism to help in absorption of treatment, it can also acts as a barrier to prevent scratching.
• Second lines agents such as ultraviolet phototherapy, prednisolone, cyclosporine and azathioprine may be considered in non responsive cases. However they are not without risk and risk/benefit ratio should be seriously discussed with the patient before any of this agents use.
• Referral to dermatologist should be needed if the condition failed to be managed at out patient setting.

  What can we do at home to help eczema patients?  

• Avoidance of heat ( in western countries, substitution of sheets and blankets for duvet might help)
• Avoidance of wool where some patients might be allergic to wool. Cotton underclothes might help.
• Humidification of environment either during day or overnight.
• Emollients for dry skin might help a lot in reducing itchiness apart of medication given by doctor.
• Remove the allergen that has been identified that cause the eczema or aggravate it
• This type of patient might have significant food allergies; avoidance of this type of food might give a tremendous effect.

     Tips to prevent infantile eczema  In many conditions, prevention is always better than cure. It has been suggested that breast milk can reduce the incidence of eczema in babies. We can also consider reducing allergen exposure through breast milk. This can achieve by encourage the breast feeding mothers to avoid all dairy products, eggs, fish, peanuts and possible soya bean in their diet. Taking calcium supplement can also help. Although infantile eczema is common, the children usually outgrow it once they become teenager.  References:

1. Clinical medicine, 4th edition, Kumar and Clark
2. Oxford handbook of clinical specialty, 5th edition