FEBRILE CONVULSIONS - Full extract 

One morning a man rushed frantically into the waiting room, carrying a baby that was having convulsions. My secretary ushered him into the treatment room and called for assistance. 

I recognized that it was a 12 month old girl called Megan, whom I had seen the previous night with a viral upper respiratory infection. Apparently her father heard a funny noise as he was driving along, and saw that she was fitting when he looked in the rear-vision mirror. She was still in her baby-capsule and was twitching in the face and arms. 

I unstrapped her, took her out of her jumpsuit, and placed her on her side on the examination couch. She was hot and perspiring freely. Her colour was good and she was breathing without difficulty. One of our associate doctors came in and asked if he could help. " Just draw me up some diazepam in case we need it," I said, but at that very moment she stopped fitting. 

The father was totally distraught. " I thought she was going to die," he said . Because Megan felt so hot we left her with just a nappy on. When I examined her, everything seemed normal, aside from a slightly reddened throat. I gave her some paracetamol drops and explained to her father that she had a convulsion due to her high fever, and that she should be perfectly okay. Because she was a little drowsy I sent her to casualty for a few hours observation and an assessment by the paediatric registrar. 

Later that afternoon the registrar rang to say that Megan had recovered fully. There had been no more convulsions and she was eating and drinking normally. It was felt that she had a febrile convulsion associated with her viral infection. No investigations were required and she was being sent home with her parents. 

She was managed with regular paracetamol and extra fluids, as well as being kept in light clothing. Her viral infection and fever subsided over the next few days. She has had no further convulsions and remains very well. 

Febrile convulsions are seizures or fits that occur in some children with a high fever. They are characterized by sudden twitching or jerking movements and the child being " out to it", completely unaware of it's surroundings. During the convulsion there can sometimes be difficulty with breathing. They are fairly common, affecting about one child in 20. 

Febrile convulsions occur between the ages of six months to five years, usually before the age of three. Although they can recur, a one-off episode is more common. Recurrent febrile convulsions are more likely if the first seizure was before 12 months of age. When this is the case the condition can run in families and is more common in boys. 

Control of body temperature depends on a sophisticated feedback system, with a mechanism like a thermostat situated in a part of the brain called the hypothalamus. In some young children this part of the brain can be very sensitive to sudden rises in temperature; an abnormal electrical discharge can occur, causing a generalized convulsion. 

The actual fever is usually caused by a viral infection and no specific treatment is necessary. However, it is important for the child to be checked after a febrile convulsion. Sometimes there can be an associated tonsillitis or an ear infection that requires antibiotics. Serious infections like meningitis also need to be excluded. 

When the convulsion is occurring, it is important to lie the child on it's side, with the head also turned to the side. As with a person of any age, never lie an unconscious or fitting child on it's back; if the child happens to vomit, inhalation and blockage of the airway can occur. And avoid putting anything in the child's mouth; it serves no purpose and may actually cause further problems. Contact medical help as soon as possible. 

If the child continues to fit, the doctor may need to use a medication called diazepam, either by intravenous injection or inserted into the rectum by a tiny plastic tube. If there seems to be difficulty breathing, oxygen may also need to be administered. If medical help is not immediately available, call an ambulance. 

Because some children have further febrile convulsions, it is important to reduce the chances of it happening again. With subsequent viral infections keep a close eye on the child's temperature. Keep the child in light clothing such as a singlet and nappy, use paracetamol as required, and give extra fluids. 

Febrile convulsions are a frightening sight for any parent to witness. However, it should be kept in mind that they do not cause death, brain damage, or epilepsy. And they are well and truly stopped by the age of six, usually earlier. 

If convulsions or seizures should occur at a time other than with a high fever, referral to a specialist paediatrician is required. Further investigation would be essential to rule out any other cause for the seizures, and medication may need to be considered. 

Health Tip:
* Febrile convulsions do not signify an underlying brain disorder. However, an urgent medical assessment is essential.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004