Handle with care

Approximately 4% of children experience febrile seizures, making it one of the most common childhood neurologic disorders. Most incidences occur between six months and three years of age, and 30%-40% of these children will experience a recurrence. The priorities in emergent management of pediatric seizures are airway maintenance, seizure termination and correction of reversible causes. When a child experiences a febrile seizure, gradual passive cooling will assist the child in terminating it. The exact cause of febrile seizures is still uncertain, but studies seem to suggest that the height of the fever is less of a factor than the rapidity of its rise. In other words, a child is more likely to seize if his or her temperature rises rapidly, even if it reaches a lower maximum temperature. The same child may slowly increase his/her temperature to a higher maximum without suffering a seizure. In this case, the patient obviously had a respiratory infection that was the source of the fever. It is important to reassure the parents in such a case of the benign nature of febrile seizures and that less than 5% of children experiencing them will develop a seizure disorder. The seizure in this case was terminated with i.v. Atvan, a drug that has been shown to work well as an anticonvulsant in children. But in most circumstances, a febrile seizure will end spontaneously or with gentle cooling. Either acetaminophen or ibuprofen can be given to treat the fever, and rectal forms of these medicines are preferred in the early treatment phase. Oral forms of the medicine can be administered after the child has stopped seizing and is not vomiting. The child should be exposed to a cooler, but not cold, environment, and the airway supported. Tepid baths can help to bring down a fever, but alcohol rubdowns or any fast cooling measures should be avoided because they may induce shivering and further elevate the fever.