Febrile_Convulsion_Flashcards
What is the typical age range for febrile convulsions?
6 months to 6 years of age.
What is the initial management during a febrile seizure?
Protect: cushion their head, do not restrain or put anything in their mouth, remove harmful objects nearby. Airway: once seizure stops, check airway and put them in the recovery position. Time duration of seizure if possible.
What should you do if a seizure lasts more than 5 minutes?
Call ambulance OR give rescue medication (buccal midazolam or rectal diazepam). Doses can be repeated once after 10 mins if the seizure hasn’t stopped. Call ambulance if 10 minutes after the first dose: Seizure ongoing, Twitching ongoing, Another seizure has started before child has regained consciousness.
What are the recommended doses of buccal midazolam for febrile convulsions?
6 months-11 months = 2.5 mg, 1-4 years = 5 mg, 5-9 years = 7.5 mg.
What are the recommended doses of rectal diazepam for febrile convulsions?
6 months-1 year = 5 mg, 2-11 years = 5-10 mg.
When should blood glucose be measured during a seizure?
If the child cannot be roused or is convulsing.
What should be done after a seizure has stopped?
Identify and manage the cause of the fever. Urgently admit any child with suspected meningococcal disease. Use the NICE traffic light system to assess the likelihood of serious illness in a child with a fever.
When should a child with a febrile convulsion be urgently admitted?
If first febrile seizure or if second seizure in a child who has not been assessed before. If < 18 months old. If there is diagnostic uncertainty about the cause of the seizure. If complex febrile seizure: focal features, seizure lasting >15 minutes, recurrence within 24h or within same febrile illness, incomplete recovery within 1h. If focal neurological deficit. If decreased level of consciousness prior to seizure. If seizure recurred in the same febrile illness (or within 24 hours). If child recently taken antibiotics as can mask signs of CNS infection. If parents are anxious and/or feel that they cannot cope.
What should be assessed using the NICE traffic light system?
The likelihood of serious illness in a child with a fever.
When should immediate hospital assessment by a paediatrician be arranged?
If first febrile seizure or if second seizure in a child who has not been assessed before. If < 18 months old. If there is diagnostic uncertainty about the cause of the seizure. If complex febrile seizure: focal features, seizure lasting >15 minutes, recurrence within 24h or within same febrile illness, incomplete recovery within 1h. If focal neurological deficit. If decreased level of consciousness prior to seizure. If seizure recurred in the same febrile illness (or within 24 hours). If child recently taken antibiotics as can mask signs of CNS infection. If parents are anxious and/or feel that they cannot cope.
What should be done if there is diagnostic uncertainty about the cause of the seizure?
Arrange immediate hospital assessment.
What should be considered if the child has no apparent focus of infection?
Consider urgent hospital assessment for a period of observation.
When should referral to a paediatrician or paediatric neurologist be made?
If neurodevelopmental delay and/or signs of neurocutaneous syndrome or metabolic disorder.
How should other children with febrile convulsions be managed?
All other children can be managed at home.
What information should be given to parents about febrile convulsions?
Inform parents about febrile convulsions: They are not the same as epilepsy. The risk of epilepsy in the future is only slightly higher than the general population. Short-lasting seizures are not harmful to the child. 1/3 children will have another febrile convulsion.
What advice should be given to parents about what to do during a seizure?
Protect them from injury. Do not restrain or put anything in their mouth. Check the airway and place in the recovery position when the seizure stops (explain that the child might be drowsy for up to an hour). Seek medical advice if the seizure lasts < 5 mins, call an ambulance if it lasts > 5 mins.
What advice should be given to parents about managing fever in children with febrile convulsions?
Reducing fever does not prevent recurrence. Explain when and how to use paracetamol or ibuprofen. Advise about maintaining adequate fluid intake. Advise on when to seek prolonged symptoms. Advise parents to carry on with routine immunisations, even if febrile seizure followed an immunisation.
Should drugs be prescribed to manage or prevent future seizures?
Do NOT prescribe drugs to manage or prevent future seizures, unless on the advice of a specialist.
What follow-up should be considered for children with febrile convulsions?
Consider primary care follow-up.
