Perspective

Convulsion caused by a fever; the harmless horror

Scene 1

She has been coughing over the last 5 days with the nose runny and recurrent sneezing. 2 years old OZK has also been having a running battle with fever which has been on and off in pattern. For each time the fever spikes, her eyes were red and she was restless. On the evening of a particular day, she went into a fit, people around thought she was dying, then within 1-2 hours she was up and about again!

Scene 2

10 months old Baby LTF was born in the slum to artisan parents. He has been having foul smelling yellowish discharge from the left ear for the past 2 months. This was associated with fever. He threw a fit during breast feeding and narrowly escaped been choked. The neighbours came, alerted by the cry for help; some shook him, some drenched him in water, another used an adult sized spoon to gag his mouth. In came an elderly woman with a burning stove and a liquid (which later turned out to be cow urine!). She grabbed the boy’s foot and held it over the flame and at the same time got someone to pour the cow urine in his mouth, the poor young man screamed in horror. After the dust had settled, he had multiple lacerations to the mouth and severe burns injury to the right foot in the short term but in the long term, disability and loss of function of same.

What it is

Febrile convulsion aka febrile seizures aka febrile fit are caused by a fever, usually those greater than 38 °C. A high temperature is a sign of infection somewhere in the body and is often caused by a virus or bacteria. A high fever does not necessarily mean the child has a serious illness. Fever is not known to cause damage to the brain or other organs. Most children with fever suffer only minor discomfort, however one child in 30 will have a febrile convulsion at one time or another. This usually happens between the ages of 6 months and 6 years. Febrile convulsions are not harmful to the child and do not cause brain damage (a harmless horror!) Most children who have a febrile convulsion will only ever have just one. Some children will have one or more seizures, usually during illnesses which cause a fever. However, febrile fits are usually harmless and almost all children make a complete recovery afterwards. It is not the same as an epileptic seizure.

Causes

The cause of the fever is often a viral illness. In most cases, the high temperature is caused by an infection. Common examples are chickenpox, flu, a middle ear infection or tonsillitis. It has also been associated with vaccination such as measles/mumps/rubella/ varicella, diphtheria etc. There may also be a genetic link. What may give it out A febrile seizure usually lasts for less than five minutes, the child will:

• become stiff and their arms and legs may begin to twitch

• lose consciousness and may wet or soil themselves

• May go red or blue in the face

• They may also vomit and foam at the mouth, and their eyes may roll back . After the seizure, the child may be sleepy for up to an hour or two. A straightforward febrile seizure like this will only happen once during the child’s illness. Occasionally, febrile seizures can last longer than 15 minutes and symptoms may only affect one area of the child’s body. These are known as complex febrile seizures.

The seizure sometimes happens again within 24 hours or during the period in which the child is ill.

What to do

The parent may not be able to make the convulsion stop.

• The most important thing is to stay calm – don’t panic.

• Place the child on a soft surface, lying on his or her side or back.

• Do not restrain the child from convulsing

• Do not put anything in their mouth, including sticks, spoons or your fingers.

Your child will not choke or swallow their tongue.

• Remove or move any objects that might harm them during the convulsions (furniture, sharp items, etc.)

• Try to watch exactly what happens, so that you can describe it to the doctor later.

• Time how long the convulsion lasts.

• Do not put a child who is having a convulsion in the bath he may drown being bathed for because he is not in control.

Care after the convulsion

Occasionally, children who have long convulsions need to be watched in hospital for a while afterwards. This is usually to work out the cause of the fever and watch the course of your child’s illness.

The child may be a little cranky for a day or so, but this will pass. Put the child to sleep at the usual time, in his or her own bed. Most children who have febrile convulsions do not have any long term health problems. They are normally healthy and grow out of them by the age of six. The catch Adequate history taking, examination and investigation appropriately directed. Treatment of the fever Once fever is noticed it is appropriate to expose the child and tepid sponge (wipe their skin with a washcloth or sponge soaked in water at room temperature to cool them down), paracetamol may further help.

Advice

See a doctor as soon as any fever-causing ailment is noticed.

 

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