SUMMARY
Journal of Islamabad Medical & Dental College (JIMDC); 1211(1):48-49
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Continuing Medical Education
Febrile Convulsion and Guidelines for Management
(Based on RCP and BPA Guideline BMJ 1991 303;634-636)
Prof. Mumtaz Hassan
Head, Department of Paediatrics, Islamabad Medical & Dental College Islamabad. (Bahria University, Islamabad)
Definition
A simple febrile convulsion is a generalized tonic–clonic
convulsion occurring in a child aged 6 months to 5 years,
precipitated by fever of more than 38°C, arising from
infection outside the nervous system in a child who is
otherwise neurologically normal.
It is typically short lasting (approx. 5 minutes)
Prevalence
➢ 3% Children are affected
➢ M/F ratio= 2:1
➢ Blacks are affected more commonly than the
Whites
Pathophysiology
Cause is still unknown. Fever, illness and age all seem to
play an important role. Some studies suggest that the
seizures are related to the sudden rise of the temperature,
while others purpose that a high sustained fever is of a
greater importance.
Aetiology
80% due to viral infections
20% due to bacterial infections
40% due to URTI’s
30% have a family history
History:
Type and length of febrile illness
Type and length of convulsion
PMH especially convulsions and development
Clinically, Characteristics of simple febrile convulsions are:-
❖ Age 6 months to 5 years
❖ Generalized tonic-clonic convulsion
❖ Less than 20 minutes duration
❖ Complete recovery within 1 hour
❖ No focal neurological signs or fundal abnormalities
❖ No developmental or neurological problems
Management:
1. Admit all 1st febrile convulsions and all ill children
2. Search for focus of infection and treat appropriately
3. No investigation is routinely necessary but;
➢ If still convulsing Check BM
➢ Consider FBC, Blood cultures, MSU, CXPto
ascertain the cause of fever.
➢ Consider LP if <12/12 age; if signs of meningism
are present: after a complex convulsion: if child is
unduly drowsy or irritable or systemically unwell.
The decision for no LP in high risk children should be made
after discussion/review by the registrar. Be aware of risk of
coning following LP in a comatose child.
4. Antipyresis -regular calpol +/- Ibuprofen
-undress child
-adequate fluids
5. Advise Parents:-
o Reassurance
o Information leaflets about nature of febrile
convulsions including prevalence & prognosis
o Temperature regulation
o First aid in a fit, and management of a
convulsion +/- use of rectal diazepam
o Take to a doctor if unwell or fit is prolonged
o Future immunization should go ahead
6. Follow up if:-
Any developmental concerns
Parental anxiety
Other pediatric or social issue
Risk of recurrent convulsions in subsequent febrile
illness:
The risk of recurrent febrile fits is 30% with no risk factors.
The risk of recurrent febrile fits is 50% if the onset is before
12/12 age or if a first degree relative has seizures of any type
or following a complex convulsion. The risk of recurrent
febrile fits is 75–100% if three or more of the following are
present:-
➢ Onset before 12/12 age
➢ First degree relative affected
➢ Complex seizures
➢ Neurodevelopment problems
➢ Adverse social circumstances
Therefore, it may be that the latter group is the one to be
given solids to take home after adequate parentral infusions.
Journal of Islamabad Medical & Dental College (JIMDC); 1211(1):48-49
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Risk of later development of epilepsy:
Risk of development of epilepsy in the general population is
0.5% by age of 25 years. Neurologically normal children
with simple febrile convulsions have a low chance of later
epilepsy; only 2.5% have had two or more febrile seizures
by 25 years of age.
Presence of complex seizures is associated with an increased
risk for later epilepsy.
Atypical / complex febrile convulsions:
• Convulsion lasting more than 20 minutes.
• Focal component to convulsion.
• Less than 6 months of age.
• More than one convulsion within same febrile
illness.
• Residual neurological deficit.
• Pre-existing neurological abnormality or abnormal
neurodevelopment.
Advice to parents- febrile convulsions:
“Your child has had a febrile convulsion. We know it was a
very frightening experience for you. You may have thought
that your child was dead or dying, (as many parents think
when they first see a febrile convulsion). Febrile convulsions
are not as serious as they appear.”
What is a febrile convulsion?
It is an attack brought on by fever in a child aged between 6
months and 5 years.
What is convulsion?
A convulsion is an attack in which the child becomes
unconscious and usually stiff, with jerking of the arms and
legs. It is caused by unusual electrical activity of the brain.
The word convulsion, fit and seizure have the same
meaning.
What shall I do if my child has another convulsion?
Lay him on his side, with his head on the same level or
slightly lower than the body not the time.
Do not try to force anything into the mouth. The hospital
may give you a medicine to insert into your child`s bottom.
This is called rectal diazepam. If the convulsion has not
stopped by the time that you have found the tube, insert it
into the child`s bottom and express the contents of the tube.
This treatment should stop the convulsion within 10
minutes. If it does not, take your child to the hospital. You
may need to call for an ambulance. Let your doctor know
what has happened. About one child in 30 have had a febrile
convulsion by age of five years.
Is it epilepsy?
No. This word is applied to fits without fever, usually in
older children and adults.
Do febrile convulsions lead to epilepsy?
Rarely. Ninety nine out of 100 children with febrile
convulsions never have convulsions after they reach school
age, and never have fits without fever.
Do febrile convulsions cause permanent brain damage?
Almost never; very rarely a child who has a very prolonged
febrile convulsion lasting half an hour or more may suffer
permanent damage from it.
What starts a febrile convulsion?
Any illness that causes a high temperature, usually a cold or
other virus infection may start a febrile convulsion.
Will it happen again?
Three out of 10 children who have a febrile convulsion will
have another one. The risk of having another febrile
convulsion falls rapidly after the age of 3 years.
Does the child suffer discomfort or pain during a
convulsion?
No. The child is unconscious and unaware of what is
happening.
What shall I do when my child has fever?
You can take the child`s temperature by placing the bulb of
the thermometer under his armpit for three minutes with his
arm held against his side. Keep him cool by taking off his
clothes and reducing the room temperature. Give plenty of
fluids to drink. Give children`s paracetamol medicine to
reduce the temperature.
The following doses should be given.
Up to 1 year one 5ml spoonful (120mg)
Aged 1 to 3 years two 5ml spoonful (240mg)
Aged 4 years and over three 5 ml spoonful (360mg)
Repeat the dose every four hours until the temperature falls
to normal, and then every six hours for the next 24 hours.
If the child seems ill or has ear ache or sore throat, let your
doctor see him in case any other treatment, such as an
antibiotic, is needed. Antibiotics are not usually necessary,
as majority of children have fever due to virus infections.
Is regular treatment with tablets or medicine necessary?
Usually not. The doctor will explain to you if your child
needs regular medicines.