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Friday, January 9, 2015
Last month a nanny rushed frantically into the office holding a 9 month old who had suddenly started thrashing, his eyes had rolled up and he didn't appear to even recognize her. He then vomited (all over the poor nanny, but bless her, she didn't even seem to notice that at the time.) By the time they arrived in our office our little patient seemed okay, but very subdued. This was the first time this child had had something called a febrile seizure. If you don't know about them, they can be terrifying. Parents who had no idea what was happening during a first seizure tell me it was the most horrifying moment of their lives. Even if you know about them, they aren't fun but trust me, it takes a huge edge off of the situation. We are seeing lots of high fevers this month so it is important that all parents know about these.
The word febrile is one of those Latin words that has made it's way into routine medical lingo. It simply means having a fever. Someone who is afebrile is fever free.
General statistics show that 4-5% of all children will have febrile seizures. We do have our share of patients in this practice who get them, but our actual percentage seems a bit lower than that. They can tend to run in a family. The symptoms may range from smaller tremors to large jerky movements. The eyes may roll back. It is common for kids to seem quite drowsy and "out of it" for a period of time right afterwards.
Most of the time the first episode happens between 6 months and 3 years. Most kids completely outgrown them by the time they are five. These seizures are NOT associated with epilepsy. The seizures themselves appear to be harmless but care needs to be taken to make sure the child doesn't sustain an injury or choke while they are seizing.
Febrile seizures usually come on when a fever is in the process of shooting up rapidly. It is rare to have them associated with a temperature under 102. If you see your child having a seizure your only job is to keep them safe. If your child is laying down, turn them on their side. Don't stick anything in their mouths. Make sure their airway remains open. Febrile seizures usually last less than 2 minutes. If you are able to stay calm enough, take a look at a clock, watch or phone to get a sense of the time. If a seizure is lasting longer than a minute (especially if it is the first time) it is perfectly appropriate to call 911. If the seizure is short and your child seems stable you don't need an ambulance, but you do need to get them some medical attention right away. One of the things we want to figure out is the source of the fever. It may be viral, but we will want to have the usual suspects ruled out (ears, throat, lungs, urine.)
With all the fevers we are seeing this season, please note that It is very common for kids who are in the process of spiking a fever to look quite pale and seem a bit trembly, that is NOT usually a seizure.
Once your child has had one or more febrile seizure, we are going to treat all future fevers with a little more care. Fevers are the bodies way of fighting an infection. As long as a fever is lower than the 101 range and the child seems happy I tend to leave the low grade temps alone and not treat. This is not the case with my seizure prone patients. Those little ones should have a plan in place to treat all fevers as soon as they are detected. This may include alternating Acetaminophen and Ibuprofen to make sure the protection doesn't wear off.
Check out the previous post on Dosages.
Posted by Nurse Judy at 9:57 AM