febrile convulsions

Question 1

epidemiology of febrile convulsions

Answer 1

occur between 2-4% of children
between 6 months and 5 years
peak incidence at 18 months

Question 2

flow chart

Answer 2

Question 3

simple febrile convulsions

Answer 3

duration less than 15 minutes, but usually less
generalised (not focal)
only 1 per 24 hours
occur in developmentally normal children
no neurological abnormalities post seizures

Question 4

complex febrile convulsions

Answer 4

prolonged >15 minutes
recur (>1 seizure in 24 hours)
focal onset

Question 5

future risk of epilepsy

Answer 5

complex febrile convulsions
family history of epilepsy
any neuro-developmental problem in the child

Question 6

approach to the child with febrile illness

Answer 6

identify source of fever
most children with simple fever require no fever investigation
children with complex febrile comvulsions may require admission and further investigations
if the child has had a vaccine in the last 14 days: fill out adverse reaction form

Question 7

investigations for complex convulsions

Answer 7

BGL
full blood count
urine MCS
lumbar puncture
chest x-ray

Question 8

initial management

Answer 8

high flow oxygen while there is a decreased level of consciousness and continuous O2 sats monitoring
take vitals
protect the patient from falls
treat underlying cause of fever
antipyretics
if going on longer than 5 minutes, treat as status epilipticus

Question 9

do antipyretics prevent convulsions

Answer 9

not be shown to prevent convulsions but may be worth considering for symptomatic relief of discomfort and pain

Question 10

discharge criteria

Answer 10

children can be discharged if they:
- had a simple febrile convulsion and are fully recovered and parents are happy for discharge with GP follow up in next few days
- have an obvious cause of fever and have been observed in ED for 2 hours post seizure