Childrens health – Febrile convulsions

   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

Differential diagnosis:

 

Treatments 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, 5th edition.
  2. Quick reference cards: medical Protection Society

Child health fact sheet : Children

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9 Responses to “Childrens health – Febrile convulsions”

  1. auto auction Says:

    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.

  2. copcar Says:

    It does exhaust the child quite dramatically…and can cause a moodiness as well. :face9:

    copcar’s last blog post..20,283 Dodge Police Cars Recalled by Chrysler

  3. Leowen Green Says:

    Dear Sir,
    I dont quite agree with your causes for febrile convulsion as febrile convulsion is a diagnosis of EXCLUSION. A doctor needs to rule out infections..eg:meningitis, pneumonia before arriving at the diagnosis of Febrile Convulsion.

    Supposed a child is having seizure with fever and diagnosed to have meningitis. then the diagnosis is Meningitis NOT FEBRILE CONVULSION.

    Conclusion, NOT ALL Seizure with fever ARE FEBRILE FITS….

    Thanks

    Leowen

  4. Dr.Irham Says:

    You are absolutely right about it. Not all patients that come with fever and seizure is febrile convulsion. But if a child between 6 months and 6 years come with these symptoms the most likely diagnosis is febrile convulsion. The point is anything that cause fever may also lead to seizure in this group of people. Of course we need to rule out life threatening conditions like meningitis, brain infections, etc. Hypoglycemia and other electrolytes imbalance may also lead to seizure. And you are right, these are not febrile convulsions.

  5. Brian@moving companies vancouver Says:

    Thanks to Dr. Irham for highlighting this fact again, the symptoms can often be misleading. Febrile convolusion /fit can send a parent in frenzy and panic can set in. I wonder if we can get reliable stats about fatal results of these fits.

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