Tuesday, 26 July 2011

Febrile Convulsions in Children - Are They Harmful?

Published in City Times

Febrile Convulsions in children … are they harmful?

Dr.Sami Aziz George, Consultant Paediatrician, Zulekha Hospital, Sharjah, dispels certain myths associated with febrile convulsions which normally affects 3% of any general child population, world over.

What is a febrile convulsion and what ages of children does it affect?
A febrile convulsion is a sudden fit or seizure that occurs in children when they have a high fever. This can happen in children aged three months to five years. The fit can last a few seconds or up to 15 minutes, and is followed by drowsiness. Most fits last less than two to three minutes.

What is the incidence of the condition in any general child population?
It is 3%, that is, one child in every 35 children gets it.

What is the chance that once a child gets febrile convulsions, it gets them repeatedly with high fever?
30% - 50% of these children might have recurrent attacks of it.

Why do these febrile convulsions happen at all in the first place?
Febrile convulsions only happen when there is a sudden rise in body temperature. The fever is usually due to a viral illness or, sometimes, it may be a bacterial infection. The growing brain of a child is more sensitive to fever than an adult brain. But why only some babies get it and not others, is yet unknown. But what has been observed is that febrile convulsions tend to run in families, although the reason for this is also unknown.

But what are the triggering factors that bring on these convulsions?
There are certain chemicals in the brain which control its neuronal actions. If these gaba receptors go down for any reason during high fever, the convulsions begin.

Apart from heredity, what are the risk factors which predisposes a child to the condition?
Most often, children inherit the tendency to suffer febrile convulsion from their parents. If either parent suffered a febrile convulsion in his or her childhood, the risk of the child getting it is 10 – 15%. If both parents had suffered the condition in their childhood, the risk is 30% - 50%. A child’s susceptibility to the convulsions also depends on how frequently the child gets infections, has high temperature – usually above 39 degrees Celsius.

Is it true that the measles content of the MMR vaccine may predispose a child to the risk of febrile convulsions?
Febrile convulsions are not directly related to the MMR vaccine as the cause. But sometimes, some vaccination might cause high fever. Measles vaccine is one of them which might bring on high fever after 2 – 3 days following the vaccination. This fever itself might be a cause of the convulsions in a prone baby, not in all children.

What are the earliest signs of an attack of febrile convulsions? What are its other symptoms?
There are no warning signals. The attack comes on suddenly and the only prerequisite for the attack is high fever. The symptoms include loss of consciousness, eyeballs roll upwards, the head head is thrown back and there will be twitching or jerking of arms and legs. Breathing may be difficult, the heart rate begins to increase, there is frothing from the mouth, there may be some cynosis, that is the child goes pale or the skin assumes a bluish colour.

When the child returns to normalcy, what will be its physical and mental state?
Some children might suffer from a slight headache, have vomiting. For a while they are a little disoriented and do not know what is happening around them. They may be in a dazed state and do not recall what happened to them. There may be some drowsy, sleepy feeling. This usually lasts for about ½ an hour to a couple of hours.

Will these convulsions harm the children, or cause any permanent injury, brain damage, etc?
Firstly, a febrile convulsion is not epilepsy and it does not cause brain damage or injure the children in any way. A normal or benign febrile convulsion will usually disappear on its own by the time the child is 5 to 6 years of age. Also, the chance of this child developing epilepsy in the future is very minimal.

Can the convulsions last for more than 10 minutes? If yes, what does it indicate? When would febrile convulsions be a cause for concern?
If the convulsions last longer than 10 to 15 minutes, we classify them as being abnormal or complicated, as being Atypical convulsions. Alternatively, the onset of febrile convulsions in a child might be very early in its life, say even before 6 months. Or if the convulsions don’t disappear by the age of 5 – 6 years. In all these circumstances, the child needs to be investigated thoroughly since the convulsions might be symptomatic of some other underlying problems which could involve the central nervous system (CNS) of the child. If the child’s EEG (Electroencephalogram) shows some abnormality or the child is having focal type convulsion, meaning, the convulsions are localized to one part of the body, that is, it has shaky hands or shaky legs only, if the child has some problem in speech, shows signs of mental retardation, these categories of children need thorough investigation. In addition, we also need to exclude certain infectious disease like meningitis.

What are the investigations that are undertaken to establish that a febrile convulsion is harmless or benign?
1. History taken from the parents to find out if they had suffered the condition in their childhood.
2. Careful clinical, physical examination of the child.
3. Blood test in babies or children who have had the attack for the first time.
4. Most importantly, the cause of the fever has to be established. In most instances, almost 75% of cases, the fever is due to a viral , upper respiratory tract infection. But some of the children may also have Urinary Tract Infection or Roseola fever.
5. In suspected cases, a lumbar puncture is done to investigate CNS involvement and meningitis, to exclude these problems.
6. EEG and MRI may be done in suspected cases.
If we are clear on all these counts, we can say with certainty that the child is having only benign convulsions which will not impair its present or future functioning in any way.

What should parents do when faced with a child who suffers attacks of febrile convulsion?
1. Don’t panic though your child may be looking horrible and as if dying.
2. Stay calm and controlled.
3. Immediately clean the mouth and nose of the child to allow it to breathe properly.
4. Carefully turn the child’s head to one side to prevent choking.
5. Do not place the child’s head in an elevated position; allow it to be resting flat.
6. Do some wet sponging to bring down the fever.
7. Don’t force anything into the child’s mouth or slap or shake it in any way.
8. If it’s a first time attack, take the child to the doctor for an examination once the episode has passed.
9. Where you fear recurrent attacks, follow medical advise on preventive and precautionary measures.

Does this mean febrile convulsions can be prevented?
Yes, with medication, whenever fever begins. The drug, diazepam, which is the normally prescribed medication, may be given orally or rectally and should be given as soon as the child gets fever. However, these medicines should not be given to those children who have the first time attack of febrile convulsions because they first need to be assessed by a doctor.


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