Dealing with Fever Convulsions

by | Sep 17, 2021

When a child develops a very high temperature, it is usually extremely distressing for parents. Should the fever cause a febrile convulsion, this naturally adds major stress to the situation. As a paediatrician and father, I can honestly say that knowing what to do in the case of a febrile convulsion and how to possibly prevent it from happening again will alleviate some of the stress.

But why does a febrile convulsion happen?
Febrile convulsions usually occur when the child’s temperature rises rapidly from a normal temperature (36,5⁰C-37,5⁰C) to a temperature of around 39⁰C and above. The young, sensitive brain is unable to cope with this rapid rise in temperature and this results in a convulsion.

How will I know if my child is having a febrile convulsion?
If your child suddenly spikes a very high temperature and then loses consciousness and begins shaking or jerking, this is a febrile convulsion. During a convulsion, the child will not be aware of its surroundings and will be unresponsive to you.

The convulsion may last for between 30 seconds and 15 minutes.

A febrile convulsion should not be confused with rigors. Rigors occur when a child is building up a fever. They often feel cold and begin to shiver. The important difference is that the child remains conscious and will respond to you. Rigors are a good warning sign that a child’s temperature is rising rapidly and it is time to take action to control the fever. If left untreated, this may lead to febrile convulsions.

If your child does have a fever, please do not put your child into a cold bath or wrap the child in wet towels. By doing this, you are lowering the child’s external temperature. The internal thermostat will continue to drive the fever higher to balance the child’s internal and external temperature. This will most certainly cause the child to have rigors. Always use medication first to control the internal temperature. After that, leave the child lightly clothed so that they can lose the temperature through the skin.

What should I do in the case of a fever convulsion?
Safety during a convulsion is the most important thing.

  • If there is anyone around who can assist, call for help.
  • The very first thing that you should do during a convulsion is to ensure that your child is breathing.
  • Move the child away from sharp or dangerous objects like the corner of a table.
  • Place your child in the recovery position. The recovery position means that the child is on their side.
  • Ensure that the head is tilted slightly backwards so that the child’s airway is open.
    Your child may vomit during a convulsion, so it is important that the airway is open to avoid choking
  • Try to time how long the convulsion lasts. This will be important information to give to the doctor.
  • Do not put anything into the child’s mouth during a convulsion. This includes medicine. The child will not be aware of having something in their mouth and may either choke or bite the tongue.
  • Once the convulsion has passed, give your child medication to bring the fever down and seek medical advice. (preferably a suppository if you have this on hand)
  • Your child will need to be comforted after a convulsion as they are likely to be confused and scared.

How is epilepsy different from a febrile convulsion?
Epilepsy and febrile convulsions are different. For a diagnosis of epilepsy to be considered, your child would need to experience at least two unprovoked convulsions. This means that there doesn’t appear to be a trigger for the convulsion. In the case of a febrile convulsion, there is a fever present. In other words, the febrile convulsion is “provoked” by a sudden spike in temperature.

Epilepsy may have significant long-term effects on the child and does require medical intervention.

Febrile convulsion, on the other hand, typically occurs in children under the age of five years. These are usually healthy young children with normal development and won’t cause any long term health issues.

Is there anything I can do to prevent a febrile convulsion from occurring?
Since these convulsions are caused by a sudden spike in temperature, it is really important that you keep medication on hand which can control the temperature if necessary.

The first-line treatment for a fever is always paracetamol. If the fever does not respond to paracetamol, then one can add in ibuprofen or another anti-inflammatory. The dosage of both medicines is dependent on your child’s weight. Be sure to speak to your healthcare provider about the correct dose, so that should your child require medication, you can give the correct dose.

A child should never be given aspirin for a fever. Aspirin can cause a very serious disease known as Reye’s syndrome so should be avoided at all times.
It is important to keep in mind that if your child has had a convulsion from a low-grade fever or if a convulsion was the first sign of an illness, then your child may be at risk of having further convulsions. A family history of febrile convulsion- may also mean that you as a parent should be on alert for this happening to your child as well.

As with any stressful situation, having what you need at hand will definitely help to deal with the situation more effectively.

Conclusion
A fever is the body’s natural response to infection, so parents need to anticipate that at some point in time and then again many times thereafter, your child will experience a fever. Some children are resilient to fevers, but an estimated 2 to 5% of children under the age of 5 years of age will experience a febrile convulsion. While this is a terrible experience for the child and the caregiver, it is important to remember that there is no evidence that short febrile convulsions cause any brain damage. In fact, studies have shown that even children who have had many and prolonged febrile convulsions achieve normal school results.

My advice to parents is always to keep on hand the medications they require to prevent a fever from triggering a convulsion. Ensure that you know the correct dose of medication for your child’s weight and regularly check the expiry dates on your medications. All parents should do a CPR (Cardio-pulmonary resuscitation) course which will provide them with skills to deal with medical emergencies because these little angels of ours usually need urgent medical attention when you are the only one present to provide it. Forewarned is definitely forearmed in the case of a febrile convulsion.

References
https://pediatrics.aappublications.org/content/142/5/e20181009
https://www.medigraphic.com/pdfs/revmexneu/rmn-2019/rmn192g.pdf
https://www.aafp.org/afp/2019/0401/p445.html
https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255

by Dr Maraschin

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