CHILDREN’S HEALTH: CONVULSIONS WITH FEVER

Convulsions are uncontrolled contractions or spasms of the muscles. If a child who has a fever goes into convulsions, there are two possible causes. The convulsions may be caused by the fever itself or by certain diseases involving the brain that also cause fever.

Febrile convulsions are convulsions that are caused by the fever itself. Five to 10 percent of all children have febrile convulsions. How quickly the temperature rises is more important than how high the temperature is. A sudden rise of only one or two degrees Centigrade may cause convulsions, but a gradual rise of two or three degrees may not.

Febrile convulsions may be thought of as shaking chills that become extreme. They are most common between the ages of three months and three years. Febrile convulsions occur less and less often from age three to age eight. After the age of eight, febrile convulsions are rare. One episode of febrile convulsions usually means the child is more likely to have them in the future. However, the tendency to have febrile convulsions does not mean the child will later have epilepsy.

Diseases involving the brain that cause convulsions include meningitis, encephalitis, and abscess of the brain. When convulsions occur with these diseases, the child will usually have a fever. But the disease (not the fever) causes the convulsions.

Signs and symptoms

During convulsions with fever, a child will fall unconscious, become rigid, and may stop breathing briefly. The child may turn blue, lose control of the bladder and bowels, and vomit. The limbs, torso, jaws, and/or eyelids will jerk uncontrollably. The child will quickly begin normal breathing again. The seizure activity may last two minutes to 30 minutes or longer. After regaining consciousness, the child will not remember that the convulsions occurred. Several traits of febrile convulsions can help you distinguish them from convulsions caused by diseases like encephalitis, meningitis, or brain abscess. A major sign of febrile convulsions is that the child recovers quickly (within minutes). Immediately after a febrile convulsion, the child is alert, can respond, and is not prostrated (not collapsed or exhausted). After a febrile convulsion, the child can bend the neck forward. There is often a family history of febrile convulsions.

After convulsions caused by diseases involving the brain, the child often cannot bend the neck forward and may be in a stage of collapse or exhaustion.

Home care

Do not panic! Protect the child from injury while the convulsion is occurring. Call your doctor immediately.

Precautions

• Do not give aspirin or any other medication by mouth to an unconscious child. An unconscious person cannot swallow and may choke on the medicine.

• Do not give artificial respiration. Breathing muscles are temporarily in spasm, and forceful artificial respiration may be harmful.

• Do not place a convulsing child in a tub of water to reduce the child’s temperature. Accidents such as scalding and injuries against the sides of the tub have occurred; this practice is not recommended.

• If the child cannot bend the neck forward after the convulsions have ended, or if the child is collapsed or exhausted, report this to your doctor. These may be signs of serious illness.

Medical treatment

Your doctor may give an injection of medication that controls convulsions—usually Phenobarbital or Diazepam. The doctor will perform a complete physical examination, taking blood tests and a spinal tap. If the febrile convulsion is unusual, or if convulsions occur often, your doctor may order additional tests such as an electroencephalogram and CAT (computerized axial tomography) scan. Daily medications to control convulsions are prescribed for several years under some circumstances.

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