First Aid Management of Childhood Febrile Convulsion

It is an epileptic seizure occurring in childhood, after age of one month, associated with febrile illness not caused by any central nervous system infection, without previous neonatal seizures or previous unprovoked seizure, and not meeting criteria for other acute symptomatic seizures. In much simpler terms, it is a seizure occurring in a previously healthy and neuro-developmentally normal child, purely due to high body temperature, due to infection elsewhere in the body that does not involve the central nervous system.
It is a quite common condition and occurs in about 25% of all children suffering from febrile illnesses. It will recur in 1/3 of these patients and eventually resolve with age without leaving any residual damage.

There are two major types of febrile convulsions

• Simple febrile convulsion

• Complex febrile convulsion

Simple febrile convulsion-

This is the most common type of febrile seizures. An episode does not usually last long; it may last only for few seconds and not more than five minutes. And it does not recur within 24 hours of the same febrile illness which caused the first seizure. Convulsion is a typical generalized tonic – clonic type without any focal neurological features.

Complex febrile convulsion-

Duration of seizure lasts more than 15 minutes and seizures may recur within 24 hours of same illness. Convulsions may be atypical or focal in type. Has a higher risk of recurring tendency and development of epilepsy in later life than simple febrile convulsions.

Clinical features-

• Sudden stiffening of limbs/body

• Rhythmic tonic- clonic movements of the limbs – in a generalized convulsion all 4 limbs are affected symmetrically. In a focal convulsion, only a side of the body/one or two limbs or a part may be involved.

• Difficulty in breathing

• Loss of consciousness

• Eyes rolling upward

• Frothing from mouth and biting tongue

• Spontaneous passage of urine /stools

• Drowsiness

• High fever just prior to the incident

Febrile convulsions are usually associated with severe parent anxiety. Therefore, first aid training should address the basic psychological counseling of parents as well as providing first aid support to the seizure itself.

First aid management-

Immediate management of seizures-

• Be calm and reassure parents not to panic.

• Keep the child in left lateral position.

• Do not put anything to mouth.

• Do not shake or move the child.

• If fit not resolved within 5 minutes contact medical assistance.

Control fever-

• Control fever by tepid sponging, fanning and removing excess clothing.

• Give antipyretics.

• Give plenty of fluids to drink to prevent dehydration.

• If the child has a personal history of febrile seizures; monitor the fever continuously and do not allow the temperatures to rise into higher degrees.

Reassure parents and care givers-

• This is not epilepsy.

• There is no harm to the brain.

• There is no damage to child’s development or future intellectual ability.

• No risk of disability.

• No need of long term drugs.

• Child can function as a normal child.

• Similar kind of seizures can occur with febrile illness.

• Seizures will disappear usually after the age of five years.

• Small percentage can go into epilepsy but it is very rare.

• No risk of death as a direct result of febrile convulsions.

When to contact a medical professional or a doctor-

• First febrile seizure

• Age less than 18 months

• Incomplete recovery after one hour

• Seizure lasting more than five minutes

• Suspicious of central nervous system infection

• Complex febrile seizure

• Fever lasted more than 48 hours before the onset of febrile seizure

• Inadequate home care

• Parent anxiety

• Low knowledge level of the parents

• Inaccessibility of hospital facilities in an emergency.

Immunization-

• If child is below four months, he/she should be assessed by a consultant pediatrician prior to vaccination.

• Vaccine for Japanese encephalitis should be given after one year of fit free period.

Prognosis-

• Has excellent prognosis in development as well as in neurological aspects.

• Risk of epilepsy after single simple febrile convulsion is about 2.5%.

• However, increasingly complex convulsions cause this risk to rise.

• Risk of having second febrile convulsion is about 30%.

• Family history of febrile convulsions among first degree relatives is also associated with increased risk of developing febrile seizures.

References:

Nelson KB, Ellenberg JH. Predictors of epilepsy in children who have experienced febrile seizures. N Engl J Med 1976; 295:1029-33.
Commission on Epidemiology and Prognosis of the International League against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993;34:592-6.
http://www.nhs.uk/Conditions/Febrile-convulsions/
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Fever_febrile_convulsions
http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm
http://www.redcross.org.uk/What-we-do/First-aid/Baby-and-Child-First-Aid/Febrile-seizure
http://www.bubhub.com.au/info/articles/baby/what_to_do_when_your_child_has_a_febrile_convulsion.shtml

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