Febrile Convulsion
Febrile Convulsion is “a seizure or ‘a fit’ occurring in a child aged from six months to five years, precipitated by fever (high body temperature) arising from infection outside the nervous system in a child who is otherwise neurologically normal”. It is commonly associated with viral infections, malaria fever, retinue of bacteria infection etc. Generally speaking, majority of febrile convulsions are not serious. This is because of complete recovery with no permanent damage after the fit.
It is estimated that about 3 in 100 children have a febrile convulsion sometime before their 6th birthday. They most commonly occur between the ages of 18 months and three years. The fever related convulsions are rare in children under six months old and over the age of six years. Causes Evidences abound indicate that a number of factors in the life and hereditary history of the child might spun such child to recurrent febrile convulsion in future.
Any illness which causes a high body temperature (fever) can cause a febrile convulsion. Examples include common illnesses like ear infection, malaria fever, coughs, colds, flu, and other virus infections. Manifestation of Febrile Convulsion For people with limited knowledge of the actual pathogenesis of febrile convulsion, the situation could be particularly alarming. Usually, the child is hot before the onset of the fit, the skin may appear flushed (though this is not easily discernable in dark skin) and their eyes may appear to roll backwards. They may appear dazed and then become unconscious.
Parts or all parts of the body may twitch or shake, what is described medically as partial or generalised tonic/clonic or tonic-clonic seizure respectively. It does not usually last long. It may only be a few seconds, and is unusual for it to last more than five minutes. The child may be sleepy for some time afterwards; he/ she might even passed urine unconsciously after the fit. An hour or so later the child often appears a lot better when the body temperature has come down. What to do for the child with febrile convulsion Timing is very important in all cases of convulsion, the longer the convulsion lasted the more likely it can cause residual neurologically problem in the brain. Hence, note the time it started. Lay the child on the side with the head turn sideway slightly lower than the body (so-called recovery position). Do not put anything into the mouth, but remove anything that could affect breathing (such as vomit or food). Do not shake the child.
When the convulsion stops, try to lower the child’s temperature to make him/her feel more comfortable. To do this take off their clothes, and give some paracetamol or ibuprofen suspension in appropriate dosage as soon as the child has recovered enough to swallow, so as to control the fever and possibly prevent another convulsion.
It should be noted here that attempting to pass any medication into the mouth of the child more often is counterproductive and potentially dangerous. The reason being that since the child is not wholly conscious of the event taking place, including the fact that the swallowing reflex may be compromised during the convulsion episode, attempt to pass in oral medications of any type may instead of going to the stomach pass into the airways and the lungs. This can lead to the development of chemical pneumonitis and pneumonia, which are potentially dangerous outcomes. What not to do with febrile convulsion The summary of the experience in practice is that ordinarily febrile convulsion will not kill the child; it is the numerous unscientific and inappropriate methods of intervention that do the damage to the child.
More often, there are reported cases of the usage of all kinds of home-made concoctions containing extracts of tobacco, paw-paw leaves, cow urine, local gin etc to abort the convulsion.
The concoctions are usually administered forcefully to the unconscious child during the convulsion episode. When these get aspirated into the airway, it damages the airway causing chemical pneumonitis, which is the inflammation of the lung fields manifesting as fever, breathlessness and, potentially, death. Preventing febrile convulsion Since febrile convulsion is related to high body temperature, it may seem logical that if you keep a child’s temperature down during a feverish illness it may prevent a febrile convulsion. However, there is little scientific evidence to prove that this is so. It is not so clear on what triggers the convulsion.
It is however possible that some body chemical that is released during certain feverish illnesses (e.g. in malaria attack) rather than the temperature itself that causes febrile convulsion. Most children with a high temperature do not have a convulsion. However, it is common practice to keep a child cool when they have a feverish illness. This will make them feel more comfortable and may possibly prevent a febrile convulsion. If a child appears hot, then the following will help to reduce the temperature.
Keep the child very lightly dressed, or take all their clothes off particularly if the room is warm. Give paracetamol or ibuprofen. Give lots of cool drinks. Prospect for recurrent episodes Only one convulsion occurs in most cases. In about 3 in 10 children who have a febrile convulsion, a second convulsion occurs with a future feverish illness. In less than 1 in 10 children who have a febrile convulsion, three or more further convulsions occur during future feverish illnesses.
A future febrile convulsion is more likely if the first occurs in a child younger than 15 months, or if there is a family history of febrile convulsions in close relatives (father, mother, sister, brother). Once the child is past three years old, the chance of a recurrence becomes much less likely.
Therefore, recurrences are not common, but it is best to be prepared. For example, practice putting children into the recovery position. Also, be confident that you know how to bring a fever down in a child.
Know how to evenly apply wet towel over the body of a child running fever without provoking chills and shivering in the child, a development that might be mistaken for another episode of convulsion; usually it is better not to simultaneously expose the child to a fast track fan. It is important to always have some paracetamol or ibuprofen in the home. Don’t get alarmed! Although alarming, a febrile convulsion is not usually dangerous. Full recovery is usual. Most illnesses which cause fever and febrile convulsions are the common coughs, colds, and virus infections which are not usually serious. However, the illness that causes the fever is sometimes serious, for example severe malaria and pneumonia.
It is important that the child should be seen by a doctor as soon as possible after a convulsion for a check over to rule out serious illness.
However, call a doctor or hospital attention urgently if: The child does not improve quickly once a short convulsion is over. A convulsion lasts more than five minutes. Another convulsion starts soon after the first one stops.
The child has difficulty with breathing