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What do you know about febrile convulsion?

 

 By Dr. Lahiru Peiris of Base Hospital Thambuttegama

As teenagers, unless you are a medical student of course, you would normally find that your knowledge about seizures, fits, and suddenly occurring medical conditions is very limited. We at Happinez aim to better lives in every way possible and thus today we have with us Dr. Lahiru Peiris explaining to you the basics about febrile convulsion.
Imagine you are in a park, travelling in a bus, or on a family vacation. Suddenly, you hear a scream or a cry asking for help. As a normal human being, your natural response is to immediately attend to that person. When you go there, you see a child, about two years old, having generalised body fits along with a frothy discharge from the mouth and eyes rolled up. If you see that for the first time you will most definitely panic, just like that child’s mother or father. So, what should you do?
First, let me explain what febrile fits or convulsions are.
A febrile fit is a type of seizure that is associated with fever, often from an infection but not due to any serious underlying pathology or an infection of the central nervous system. It occurs in children from six months to six years of age without any developmental anomalies or delays. To warrant a diagnosis, he/she should not have any past history of afebrile seizures (fits without fever). This is one of the commonest causes of emergency hospital admissions in Sri Lanka.
A febrile convulsion can be divided into two main groups as shown in the table.

 

SimpleComplex
1. Lasting 1-2 mins1. Lasting > 15 mins
2. Generalised2. Focal
3. One episode in 24 hours3. Two or more episodes in 24 hours
4. The chance of getting long-term fits (epilepsy) is less4. Epilepsy risk is high
5. No neurological deficit5. Can cause neurological deficit

 

Still, the causes and risk factors are unknown, but there are a few conditions that can trigger a febrile convulsion such as a viral infection, a less common bacterial infection, post-immunisation, being within the age range of six months to six years, and also family history.

Complications may arise such as food aspiration with an acute attack of febrile convulsion, but chances of having delayed motor development or cognition are unlikely.

How do you identify a febrile convulsion attack?

 

  • Partial or complete loss of consciousness
  • Generalised or localised stifling or jerking or both
  • Frothing from mouth
  • Eyes rolling upwards
  • Change in body colour (pale or bluish)
  • Breathing difficulty
  • High fever
  • Age of the child

 What to do during a febrile convulsion

 

  • It is normal to panic and feel helpless but in order to help you need to remain calm
  • It is important to time the convulsions since it’s one criterion which you can use to differentiate between simple and complex seizures
  • Keep the baby away from any danger. For example, electric wires, fire, or sharp instruments
  • Do not gather around the baby as it blocks ventilation
  • Keep a folded piece of cloth or something soft under the head to protect it
  • Turn the baby to the left lateral position, flex the left knee, and protect the airway
  • Usually, you don’t have to call 119, but if you’re uncertain about the child’s condition, it is better to call the emergency number. This is especially so if the seizure continues for more than five minutes, or there are repeated seizures without gaining consciousness, any type of injury before or after the seizure, or any past history of convulsion without fever
  • Stay with the baby and his/her mother or father to calm them until the baby gains full consciousness
  • Start tepid sponging after recovery if the baby still continues to have the fever

What NOT to do during a febrile convulsion

 

  • Don’t put anything inside the mouth
  • Don’t keep metal on hands or feet
  • Don’t prevent movements
  • Don’t use a tepid sponge during an attack
  • Don’t let the mother feed the child immediately after recovery

Usually, mothers will immediately carry their babies to the hospital even after they have regained full consciousness.
In the hospital setup, we immediately admit the baby and observe and manage him/her in a high dependency unit.
Starting with keeping the baby in the left lateral position and right knee flexed, checking his/her oxygen level (SpO2), checking blood sugar, and having standby oxygen, and other emergency drugs and instruments. Once the baby is settled, we usually counsel the mother about future occurrences, the current condition, dos and don’ts during an attack, and other relevant information.
Investigations are rarely done during febrile convulsions, especially during simple febrile convulsions.
However, simple investigations like full blood count and urine full report can be performed to find the cause.
In some complicated conditions, advanced investigations like EEG (electroencephalogram), MRI (Magnetic resonance imaging), or lumbar puncture can be performed.

Doctor’s tips

  1. Febrile convulsions are one of the commonest reasons for hospital admissions in Sri Lanka
  2. It is common in kids between the ages of six months and six years
  3. It is always associated with fever

4.Turning the baby to the left lateral position is the first line of treatment

  1. Every parent should be aware of this condition 
  2. Tepid sponging is useful to prevent febrile convulsions