Febrile seizures - First Aid

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First aid

First aid

Emergency intervention in children

Sunburn in children Diaper rash Febrile seizures The child who does not sleep Acute asthma access Dental trauma Head injury
  • Sunburn in the child
  • Diaper rash
  • Febrile seizures
    • What are febrile seizures
    • Causes
    • What tests to do
    • Risk of occurrence of late epilepsy or other outcomes
    • Drug therapy of the crisis
    • Crisis prevention
    • When to bring the child to the hospital
    • What to do during the crisis
    • What to do after the crisis
  • The child who does not sleep
  • Acute asthma access
  • Dental trauma
  • Head trauma

Febrile seizures

Attending a febrile seizure of your child is always a cause of alarm and distress in parents. The disturbance generally lasts a few minutes, but it can give the impression of an attendant to spend an eternity. Many parents are afraid that the child may die or have brain damage: in fact, febrile seizures are a less dangerous phenomenon than it might appear. It is generally a benign problem not associated with important neurological pathologies and that generally does not involve future outcomes. The disorder generally affects about 2-5% of children, and males more frequently than females. If you only consider children who have a parent or sibling who has suffered from febrile seizures, the frequency goes up to 10-20%. The typical age of appearance is between 6 months and 5 years, with the maximum frequency in the second year of life. In 1/3 of children, episodes tend to repeat.

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What are febrile seizures

Febrile seizures are seizures that occur in the absence of other signs of neurological disease or brain infection. They are phenomena related to a transitory and reversible situation, facilitating convulsions: fever. During the crisis the child can roll his eyes back, stiffen and / or shake his limbs in a more or less intense way, lose consciousness, have a shortness of breath, urinate, vomit, cry or complain. A simple febrile seizure (see box "Types of seizures") generally ends, without any intervention, in a time ranging from a few seconds to 10 minutes.

Relapse can occur within 6 months of the first seizure episode in 50% of children. Relapses affect about 33% of children, with a higher risk for children who had the first ongoing fever crisis that lasted only one hour or if the first episode occurred within the 1st year of life. Relapses are more frequent even in children who are familiar with this problem, if the first crisis lasted a long time or had the characteristics of complex convulsion.

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Causes

In predisposed children, the febrile seizure can occur whenever the body temperature rises rapidly. The trigger seems to be represented more by the speed with which the fever rises than by the final temperature that is reached. However, fever is not the only factor that contributes to determining this disorder: age and familiarity are other predisposing elements. Between 6 months and 5 years, for example, factors tolerated very well in later ages, can cause convulsion. Typically, after the 5th year of age, febrile seizures become exceptional. There is an individual predisposition to febrile seizures that appears to be genetically determined, and in more than 1/3 of cases there is a family history of seizures, meaning that the risk is much higher if a parent or sibling has had this problem.

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What tests to do

Normally, a child who has had a febrile seizure has no symptoms other than those of the disease that caused the fever, and the neurological examination after the crisis must be normal.

The convulsion can appear during any feverish disease, and generally laboratory tests can only be used if the symptoms present do not allow the diagnosis of the disease causing the fever to be made.

Since the child has usually recovered when he arrives at the emergency room, the information that the parents can provide is valuable to allow the doctor to correctly frame the seizure episode.

It is therefore essential, even if understandably frightened, to make a local mind about the duration of the crisis and its characteristics (how long did it last? The contraction and the shocks were symmetrical or only affected one side of the body? Did the child lose consciousness?) .

If the convulsion involved a child aged between 6 months and 5 years, it lasted less than 15 ', was not unilateral or partial, manifested during a febrile infectious disease and at the end of the episode the child does not present signs that could cause fear of a neurological impairment of another nature, the doctor can reasonably orient himself on a diagnosis of febrile convulsion and not perform any assessment, if not those useful to make the precise diagnosis of the disease that caused the fever.

The electroencephalogram (EEG) performed both immediately and after a few weeks is not used to diagnose febrile convulsion or to rule out a potential epilepsy.

Equally unnecessary are tests such as CT and MRI.

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Risk of occurrence of late epilepsy or other outcomes

The general risk of betraying epilepsy is very low, but there are some elements that, if present, may increase this probability: the presence in the family of other people with epilepsy, previous electroencephalogram (EEG) anomalies, age less than one year at the time of the first crisis.

However, there is no evidence that simple febrile seizures can cause brain damage, mental retardation, impaired cognitive ability or learning disabilities.

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Drug therapy of the crisis

The drug to use, as soon as the crisis occurs, is diazepam (ValiumĀ®). 5-7.5 mg is administered rectally per dose, equal to half-two thirds of a 10 mg ampoule. It can be repeated after 10-12 hours in case of a new crisis. The administration of the drug rectally can also be done with a normal syringe to which to attach a tube, externally anointed with oil: the diazepam is sucked from the vial, the tube is hooked in place of the needle, it is introduced into the anus to 5 cm and pushes on the plunger of the syringe until the whole dose is administered.

Considering also the emotional situation that parents experience at the time of the crisis, even if it is more expensive, it is certainly much more practical to use the ready-to-use 5 or 10 mg diazepam enemas that are found on the market.

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Crisis prevention

Since febrile seizures represent a transient phenomenon that leaves no consequences and that resolves itself over time, it is not necessary to do any treatment aimed at preventing the appearance of new episodes.

By the way, drugs that could prevent seizures have important side effects and do more harm than good.

Considering that seizures often occur for minimum fever levels, if you have not yet noticed that the child is sick, it is not possible to prevent crises even by administering an antifebrile drug promptly.

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When to bring the child to the hospital

After the first episode of febrile convulsion, the child should be visited as soon as possible, preferably in an emergency room where, if the crisis does not spontaneously stop after 10-15 minutes or if signs of neurological suffering persist at the end of the crisis, it will be It is possible to carry out the most appropriate investigations.

It is good to bring the child to the hospital in case of subsequent seizures and if repeated seizures occur during the same disease, if the seizures are different from those of the previous seizures, if the child appears sleepy, confused, excessively agitated or if he has tremors, abnormal movements or cannot coordinate movements.

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What to do during the crisis

If the child has a seizure, try to stay calm and act like this:

  • put the child lying on his side, better on the floor on a carpet, with his head lower than his hips (for this purpose, insert a pillow under his side resting on the ground);
  • remove all objects on which it could collide with the risk of injury;
  • loosen the clothes around the neck and waist;
  • if the baby was eating, try to remove the food residues from the mouth (use the hook index finger);
  • do not try to give him fluids;
  • stay close to him, checking your agitation as much as possible; comfort him without shaking or blocking him;
  • if you already have the drug at home and within 5 minutes the crisis has not resolved, administer diazepam rectally;
  • if the crisis does not resolve with the drug, call 118 or take the child to the emergency room.

seizures make a great impression and, although often very short, seem to last an eternity. If possible, try to evaluate the duration of the crisis by checking the time on your watch. The data is essential for deciding whether to use rectal diazepam, bring the child to the emergency room or call 118 and to be able to report it to the doctor. Remember that often, an hour or two after convulsion, a child plays and runs as if nothing had happened. If you can stay calm and assist him without too much agitation you will help him to the best of your ability.

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What to do after the crisis

On the occasion of a new crisis, when a diagnosis of febrile seizures has already been made, if the child recovers within 10-15 minutes and none of the signs described above is present, it is not always necessary that he be visited by a doctor. In fact, the crisis often appears in the first moments of the disease causing the fever and the symptoms that allow the pediatrician to move towards a diagnosis may be completely lacking. If the baby wants to rest, put him in a comfortable position, keeping him under control, and contact the pediatrician by phone to ask him for advice on how to behave in the following hours or days.

It is useful to warn the child about all the people who interact with him (babysitter, kindergarten teachers, kindergarten teachers), but it is essential that anyone who takes care of the child is able to better cope with the eventuality of a new crisis. These people should be informed of both the relative benignity of the disorder and the symptoms that signal an alarm situation. Given that the crisis generally ends in a short time, it is practically impossible for you to arrive from the workplace in time to be of real help to the child. It is therefore important that these people understand that the top priority is to assist the child, take care of him and give him diazepam, and only then contact you to warn you or call 118 if the crisis does not resolve itself within 10 minutes. The intervention of the pediatrician may be useful to inform and reassure the staff of the infant community that is attending the child.

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