Paeds- Febrile Seizures + Sudden Infant death Flashcards
1 in how many children will have a febrile seizure?
a) 1/25
b) 1/5
c) 1/75
d) 1/50
a) 1/25
Febrile Seizures are relatively common, occurring in 1 in every 25 children
How long does a febrile seizure last on average?
a) 15s
b) 30s
c) 90s
d) 300s
c) 90s
Febrile seizures are seizures that occur with a fever. They usually last approx 90 seconds
After how long does a febrile seizure become a medical emergency?
a) 2 minutes
b) 5 minutes
c) 10 minutes
d) 15 minutes
d) 15 minutes
What is a ‘Febrile seizure?
• Febrile seizures are seizures that occur with a fever
‘Febrile seizure usually occur in…
children under 5 years old
Fevers may be caused by any infection including….
g URTI,
pneumonia,
gastroenteritis,
ear infections
or meningitis.
Why are children more prone to seizures?
• Children in general have lower ‘seizure thresholds’ than adults making them more prone to seizures.
in the early stages of illness when there is a rapid rise in body temperature could lead to….
febrile convulsion
Symptoms of febrile convulsion
- High temperature (>38 degrees Celsius)
- Body stiffening
- Sharp jerking movements of arms and legs
- Arched back
- Eyes rolled back
- Child unresponsive during seizure
- Breathing can become irregular
- Incontinence (fecal or urinary)
- Often post-ictal drowsiness
What to look out for in a history presenting with fever
- May be no prior history of illness.
- Child may be systemically unwell before seizure, with increased temperature, Increased RR, vomiting, out of character.
- Seizure could also occur before anyone realizes child is unwell.
- After having one febrile seizure, 1/3 children go on to have another one.
- 1/15 children will go on to have three or more febrile seizures
. • May run in families.
Ix for febrile convulsion
Diagnosis is clinical
• Tests may be required to identify source of fever
. Investigations to consider:
- Lumbar puncture
- Rule out meningitis
- Viral studies
- Blood culture
- Bacteremia?
- EEG
- Brain MRI
- Consider in child with abnormal development, history or neurological examination.
- FBC
Differential Diagnosis for febrile seizure?
- Bacterial meningitis
- Viral meningitis
- Viral encephalitis
- Epileptic seizure
- Hot water epilepsy : Focal seizure after bathing in hot water.
- Breath-holding spells : Afebrile infant with apneic attack and short generalised episodes of jerking after crying spell
What examinations would you for suspected febrile seizure?
- Dermatology examination
- Respiratory examination
- Ear examination
- Gastrointestinal examination
Rule out meningitis • E.g. lack of nuchal rigidity and focal neurological abnormalities
After one febrile seizure, how many children go on to have another?
a) 1/3
b) 1/5
c) 1/10
d) 1/15
a) 1/3
A surprisingly large number of children will then go on to have another febrile seizure in the future
Most important differential diagnosis to rule out? febrile seizure
a) Epilepsy
b) Viral meningitis
c) Bacterial meningitis
d) Hot water epileps
c) Bacterial meningitis
Bacterial meningitis can cause many long term complications in children
What temperature is needed to diagnose a febrile seizure?
a) 37.5 Degrees Celsius
b) 39 Degrees Celsius
c) 38.5 Degrees Celsius
d) 38 Degrees Celsius
d) 38 Degrees Celsius
Other symptoms include body stiffening, sharp jerking movements, arched back and eyes rolling back.
Which of these is a risk factor for SIDS?
a) Prone sleeping position
b) Being breastfed
c) Using a dummy
d) Sleeping in the parental bedroom
a) Prone sleeping position
What needs to be ruled out before SIDS can be diagnosed?
a) Accidental suffocation
b) Non-accidental death (abuse/trauma)
c) Respiratory infection
d) All of the above
d) All of the above
What is the prevalence of SIDS in the UK?
a) 1 death per 1,000
b) 0.6 per 1,000
c) 0.1 per 1,000
d) 0.3 per 1,000
d) 0.3 per 1,000
Sudden Infant Death Syndrome’ is also known as?
cot death
What is ‘Sudden Infant Death Syndrome’
Defined as ”The sudden death of an infant under 1 year, which remains unexplained after thorough case investigation including autopsy, examination of scene and review of history”
Sudden Infant Death Syndrome’ is of the leading cause of
post-neonatal infant death
WHat is Triple-Risk Hypothesis
The triple-risk hypothesis explains SIDS by three factors converging to result in infant death.
What are the three factors in Triple-Risk Hypothesis SIDS
- A vulnerable infant - prematurity, low birth weight
- In a critical period during homeostatic control development
- An exogenous stressor – smoke exposure, sleep, over-heating
What does BRUEs stand for?
Brief resolved unexplained events
SIDS risk factors?
- Sleeping position – Prone or side sleeping
- Sleeping surface - soft
- Sleeping arrangements
- Smoke exposure
- Not being breastfed
- Prematurity
Signs of a BRUE
- Cyanosis
- Breathing difficulties
- Abnormal limb movements
BRUE
Hx questions to ask?
- Did the infant have a foreign body ingestion?
- Does the infant have a history of apnoea?
- What was the time and amount of last meal?
- Was the baby asleep or awake?
- How did the baby seem before BRUE?
- What was the child’s position?
- Did the infant change colour?
Investigations for SIDS
- Blood culture – evaluation for bacterial, viral and fungal pathogens
- CSF culture – as above
- Urine culture – as above
- Serum chemistry – results negative for other metabolic causes
- Photographic record – negative for bruising, haemorrhages or other skin findings
- Skeletal survey – negative for bone injuries
Differential Diagnosis for SIDS
• Accidental suffocation – sign of entrapment between two surfaces, accidental strangulation or suffocation against bedding
• Non-accidental trauma or abusive injury – bruising in unusual places, rib fractures, spiral fractures of long bones and retinal haemorrhages
• Respiratory syncytial virus – can be tested for by nasal swab. Upper respiratory symptoms of cough and nasal congestion.
• Pertussis – as above
Tx for SIDS
• Carer follow-up and grief counselling
Which of these is a risk factor for SIDS?
a) Prone sleeping position
b) Being breastfed
c) Using a dummy
d) Sleeping in the parental bedroom
a) Prone sleeping position
