Febrile convulsions
What is a febrile seizure?
A seizure in an otherwise neurologically normal child aged 6m-6y associated with a fever caused by an infection or inflammation outside of the CNS
What is the management of a febrile seizure if the child is actively fitting?
ABCDE Check glucose Follow seizure guidelines
When should admission be considered in a child with febrile convulsions?
Child is <18 months old More than usual parental anxiety or parents feel unable to cope Child currently/recently taking abx No clear focus of infection
When must a child with febrile convulsions be admitted?
Complex febrile convulsions Drowsy/vomiting >1h post-seizure Cause of fever requires hospital treatment Signs of CNS infection or serious illness pre- or post-seizure
What are the considerations for long-term management in febrile convulsions?
Follow-up Discharge advice Inform parents what to do in the event of another seizure Advise parents about managing fever Advise parents to continue immunisations
What are red flags for febrile convulsions?
Meningitis and encephalitis
What is the management of a simple febrile convulsion?
Observe in CED until: Child has fully recovered Confident no features of CNS infection or serious illnesses Child has adequate oral intake No need to wait for control of fever is child is well, discharge with advice
What discharge advice should be given to parents of a child with febrile convulsions?
PIL Febrile seizures are not the same as epilepsy and the risk of epilepsy developing is low but slightly higher than in the general population Short-lasting seizures are not harmful to the child 1/3 children will have another febrile seizure
What are important features of the history in a febrile seizure?
Pre-fit state - neurologically normal? drowsy/meningitic? symptoms of illness? Parents perception of fever Seizure details: onset, duration, focal features, recovery time
What instructions should be given to parents for the event of another seizure?
Protect child from injury, don't restrain or put anything in the mouth Check the airway and put in the recovery position when the seizure stops Explain the child may be sleepy for up to an hour after the seizure Seek medical advice if the seizure >5 mins (111/GP), call ambulance if >5mins
What are key features of the examination of a child with febrile convulsions?
Signs of meningitis Signs of sepsis Signs of pneumonia ENT Rashes
What is the difference between simple and complex febrile convulsions?
Simple: Isolated, generalised tonic-clonic Duration <15 mins Do not recur within 24 hours or in same febrile illness Complex: Focal onset or focal features during fit Duration >15 mins Recurrence within 24 hours or same febrile illness Incomplete recovery within 1 hour
What investigations can be done into febrile convulsions?
Urine dip (+forced culture is <1y) Bloods - FBC, CRP, culture CXR (?pneumonia)
What are common causes of febrile convulsions?
Viral infections (URTI, roseola, chicken pox) Otitis media Tonsilitis Gastroenteritis Post-immunisation UTI LRTI
