Febrile seizures are convulsions that can happen during a fever (febrile means "feverish"). They affect kids 3 months to 6 years old, and are most common in toddlers 12–18 months old. The seizures usually last for a few minutes and are accompanied by a fever above 100.4°F (38°C).
Remember these are very distressing to parents!
Establish that this is an uncomplicated, febrile convulsion:
· Usually between ages of 6/12 & 6 years,
· Occurs when fever rapidly rises above 38.5,
· Generalized, single seizure of short duration (<10 mins.),
· No focal neurological findings,
· There must be an identifiable fosus of infection.
40% are recurrent esp. in the < 1 year age group.
Risk of subsequent afebrile seizure .
1. ABC’s, Resuscitate as indicated,
2. 100% Oxygen,
3. IV access,
4. Check BSL,
5. Diazepam IV (0.2 mg/kg) or Midazolan IV or IM (0.1 mg/kg),
6. May give rectal Diazepam (0.5 mg/kg) if IV access difficult,
7. If status develops give phenytoin IV 15-20 mg/kg over 20 mins. Followed by 3mg/kg IV
every 6 hours. If under 3 months use phenobarbitone IV 20 mg/kg over 20 mins.
Followed by 5 mg/kg/day in three doses,
8. A “septic work-up”, including LP, is recommended in:
· All children <6/12 old,
· In all those with seizures >10 mins &
· Anyone with clinical signs suggestive of meningitis.
9. As a general rule a child with an uncomplicated, brief febrile convulsion who has made
a full recovery & has good social set-up can be discharged after a period of observation,
although often admission for observation is more preferable option by parents,
10. Always discuss with LMO prior to potential discharge,
Any child who is discharged should be reviewed within 24 hours