It’s another busy night in the pediatric emergency department, often 5-6 children with fever and convulsions are seen one after another in one night. In the face of anxious and nervous young parents, in the face of children who are convulsing or convulsing and still have high fever and unstable condition, the doctor often asks about the condition of the child while assessing the child’s consciousness, pupils, breathing, heart rate, color, skin circulation of the limbs and body temperature, taking measures to reduce the fever, stop and prevent further convulsions. Depending on the condition, the doctor may choose to do cranial imaging (such as cranial MRI or head CT), electroencephalography or cerebrospinal fluid examination, etc. Some children are diagnosed with intracranial infection, while others are diagnosed with febrile convulsions. Some children are diagnosed with intracranial infection, while others are diagnosed with febrile convulsion.
What are the clinical characteristics of febrile convulsions?
First, febrile convulsions are one of the most common causes of convulsions in children and one of the most common emergencies seen in pediatric emergency departments. The incidence of febrile convulsions is 2-4% in China, which means that on average, 2-4 out of every 100 children have a history of febrile convulsions. Febrile convulsions usually occur in the acute phase of upper respiratory tract infection or the early stage of other infectious diseases, and they occur within 24 hours of the heat course, especially when the body temperature rises suddenly, and they are more likely to occur, and if febrile convulsions are diagnosed and treated promptly, the outcome and prognosis are mostly good.
Secondly, what are the diagnostic criteria of febrile convulsions?
① The age of first onset is mostly from 6 months to 6 years;
② Convulsions mostly occur within 24 hours of fever, and convulsions are likely to occur during the period of sudden rise in body temperature;
(3) Convulsions are accompanied by fever, and the body temperature is often over 38.5℃ before and after the attack;
④ Convulsive seizures are often characterized by generalized or localized muscle tonicity, spasms or jerking, unconsciousness, no answer to the call of relatives, and may be accompanied by upward staring or squinting of the eyes or daze, closed teeth, foaming at the mouth, slight cyanosis, with or without urinary or fecal incontinence. The duration of the attack may vary from a few seconds to a few minutes, and the mental response resumes quickly after a short sleep with natural remission, usually only one attack in the course of a fever, but there are also multiple attacks.
It is necessary to exclude convulsions caused by intracranial infections, gastrointestinal infections combined with electrolyte disturbances and serious infections, poisoning complications associated with encephalopathy.
In addition, there are two types of febrile convulsions:
1, simple febrile convulsions
The age at the time of seizure is mostly between 6 months and 6 years;
The body temperature is often over 38.5℃ before and after the onset;
ƒ Most of the seizures are generalized tonic or generalized clonic symmetric seizures that last from a few seconds to a few minutes;
” Only one seizure in the course of a febrile illness;
… previous psychomotor development was basically normal;
† The EEG returned to normal on reexamination 10-14 days after the fever subsided.
2. Complex febrile convulsions
Age at seizure < 6 months or > 6 years;
’ Temperature < 38.5℃ before and after the onset;
ƒ More than two or more recurrences within 24 h;
” Convulsions lasting more than 15 minutes;
Pre-onset abnormalities of central nervous system development (e.g., mental retardation, brain injury, or cerebral hypoplasia), or family history of epilepsy;
† The EEG is still abnormal on recheck 10-14 days after the fever has subsided.
The prognosis for children with simple febrile convulsions is good and will not leave sequelae; complex febrile convulsions will have adverse effects on the brain development of a few children, and some children will still have recurrent convulsions after the age of 7. Children with recurrent convulsions and not accompanied by fever eventually become epileptic and require long-term antiepileptic drug treatment.
Second, the following is a Q&A with parents about pediatric febrile convulsions
Neither my loved one nor I had febrile convulsions when we were young, so why would my child have them?
It is true that febrile convulsions are associated with genetic factors: studies have shown that about 33.7% of children with febrile convulsions have a positive family history, that is, relatives who have had febrile convulsions; in addition, the development of neuromyelin in the brain of infants and young children is not yet mature, and they are relatively sensitive to the stimulus of high fever, and it is not until the age of 6 that the maturity of neuromyelin in the brain of children reaches 90% of that of adults, so febrile convulsions are more likely to It makes sense that febrile convulsions are more likely to occur in children between the ages of 6 months and 6 years. Also, a small number of parents do not know if their baby had fever convulsions when they were young and ask the elderly to find out.
When a baby has a convulsion, the elderly tell us to squeeze the child’s human middle quickly.
A mother said that when she saw her baby’s eyes rolled up, her teeth clenched and her face changed, she felt so nervous that her family asked me to squeeze the child’s midsection, and I squeezed until the child’s convulsions stopped before letting go. In fact, most of the pediatric convulsions are short, generally not more than 5-10 minutes, most of the minutes to terminate the seizure on its own, at this time, the convulsions will not be dangerous to the baby’s life, just try not to make the vomit, including oral secretions and sputum, is mistakenly sucked into the trachea, the final airway blockage, causing asphyxia hypoxia will lead to adverse consequences; so, the scientific Medical guidelines will inform that when a small child has a convulsion, do not pinch or force the flap to straighten the bent limb, which cannot end the seizure and will only increase the damage.
What else should we pay attention to when a baby has a convulsion?
Lay the baby flat on the bed or a flat place to prevent falling or bruising;
Turn the baby’s head to the side and clean up any drool or vomit in time to prevent accidental aspiration;
Do not put anything into his mouth because tongue bite rarely occurs; if something is forced into the baby’s mouth, it may cause the baby’s milk teeth to fall out, and if by chance the milk teeth fall into the trachea, a foreign body in the bronchus will occur, partially blocking the airway and risking asphyxiation;
If the seizure continues for more than 10 minutes and does not end on its own, the child should be immediately taken to the pediatric emergency department of a nearby hospital for first treatment.
My child had a febrile seizure, can I take Valium to prevent it completely when he has a fever again?
If your baby has a history of febrile convulsions, a second febrile convulsion may occur before the age of 6-7. If your baby has a fever of more than 38°C, you can take Valium once along with antipyretics; if the temperature rises again after 4 hours, you can take another Valium.
My baby had his first febrile convulsions at just over 6 months of age, followed by 6 recurring attacks within a year, and the doctor said to take long-term medication to prevent attacks, but we were worried that the medication was bad for the brain!
There are several conditions that require long-term antiepileptic drugs to prevent febrile convulsions from recurring.
(1) Recurrent febrile convulsions, more than 3 seizures in 6 months and more than 5 seizures in a year;
(2) The occurrence of febrile convulsions lasting for a long time, more than 30 minutes, this condition is also called persistent status epilepticus;
(3) A small number of children have febrile convulsions that turn into non-febrile convulsions, and repeated seizures are confirmed as epilepsy;
Because, the more severe the above conditions are, the risk of adverse effects on the baby’s brain development increases. There is a structure in the brain called hippocampus, which, if damaged by repeated febrile convulsions in preschool, may form epileptic foci and increase the potential risk of secondary epilepsy in adulthood. Therefore, long-term prophylactic medication should follow the indications for medication and the importance of brain protection in developing small children should be taken into account when choosing which medication to use to prevent recurrences, and the appropriate medication should be selected by the physician for treatment.
There are criteria for the diagnosis and treatment of febrile convulsions, but each baby’s specific situation is different, so a case-by-case analysis is needed, and the doctor needs to give rationalized advice based on the baby’s characteristics.