Fever in a child

Question 1

What are the age groups, symptoms and signs you’d expect in someone with a febrile convulsion? What differentiates between simple and complex?

Answer 1

• 6mths to 6 years of age.
• <6mths rule out serious cause (meningitis).
• 3% of healthy children (common)
• Associated with viral infections and fever
• Simple vs complex:
  
  • Simple (tonic clonic <15mins don’t recur in same illness)
  • Complex: odd beginning (focal signs), odd middle (longer than 15), odd end (incomplete recovery in 1 hr), odd again

Question 2

What adivce do you give to parents taking a child who has had a FC home?

Answer 2

• Seizure at home
  
  • stay calm,
  • baby to just have it,
  • on a soft surface and lie supine.
  • Don’t put in water and don’t put anything in their mouth
• When to call ambulance
  
  • Seizure longer than 5 mins
  • if you’re worried call the ambulance. Do not drive them into hospital. Drive safely when driving in the car (maybe if 2 adults).
  • Child unresponsive after
  • Looks really unwell.
• Factsheet
• F/U with GP

Question 3

What is the management of Febrile Convulsions in Hospital?

Answer 3

• 5-10mins supportive care, right position, away from injurious agents
• Adequate airway and breathing.
• Persistent seizure, active management:
  
  • O2
  • IV access,
  • check glucose - BSL (easy to fix),
  • calcium (hypocalcemia is a cause - absent in Vit D deficiency), - easily treatable.
• Benzodiazepines, 5 mins benzos , another 10 - phenytoin
• Reassurance
• Panadol for pain and discomfort. Doesn’t decrease risk of FC or reduce the fever, only for discomfort
• Treat cause of the fever.

Question 4

Prognosis of FC? What is the change of getting epilepsy?

Answer 4

• Low risk of neurological complications
• Good prognosis for remisiion of FC, 50% risk of recurrence if 1 year old, 30% RRC in 2 years old.
• If you have RFs then risk is different:
• FHx of epilepsy
• Neurodevelopmental problem
• Atypical FC (prolonged or focal)
• 1% for epilepsy in general population, 1 RF = 2% of epilepsy, more than 1 = 1 10% risk of epilepsy
• Follow up visit

Question 5

What is the definition of febrile? How do you measure it?

Answer 5

• >38 degrees rectally (closer to core body temp)
  
  • do rectal in neonates
  • 5-6 years don’t need it but less accurate tests:
    
    • tympanic
    • axilla
    • skin
    • patch on stomach

Question 6

Some broad categories of causes for fever, what associated features would you look for?

Answer 6

• Infection (viral or bacterial)
• Cancer (leukemia (<5), lymphoma)
• Rheumatological
  
  • familial (mediterranean)
  • cyclical fever syndromes
  • IBS
  • Juvenile arthritis
• Drug reactions
  
  • SSRI overdose

Rashes:

• Purple nonblanching worried about meningococcal
• petechiae
• purpura
• torso/arms

Question 7

What is the risk of serious bacterial infection in a 2 month old?

Answer 7

• 7% have serious fever
• 7% have infection if you look
• rest are viral and well

Question 8

Talk through septic screening and conditions when you’d do it?

Answer 8

• all babies go to the ED if >38 temp
  
  • Most get LP (esp if <3mths)
    
    • ratio of RBC to WBC
    • WCC
      
      • platelets and WCC up
      • leukocytosis bacterial
      • platelets are an acute phase reactant
  • FBE
  • CRP
  • film
  • glucose
  • UTI
  • blood culture
  • +/- CXR - recession

Summary:

• <3mths always LP
• >3mths +/- LP

Question 9

What is the treatment for a febrile child?

Answer 9

• antibiotics - with no diagnosis you want to treat for sepsis (not meningitis)
  
  • febrile and unwell IV anitbiotics until you have a blood culture and no organism on urine
• >2mths fluclox and 3rd gen cephalosporin
• <2mths benz pen + 3rd gen cephalosporin
• ceftriaxone in older children
• if you’re worried about staphylococcus add flucloxacillin
  
  • e.g. umbilical cord