How to deal with convulsions in kids
Dear Dr. Donya,
My son Brian (now 18 months old, 15 kilograms in weight, 88 centimeters tall), 2 months ago, at the age of 16 months, had a seizure, preceded by a high fever caused by a bad cold. His body temperature was 39.5 degrees Celsius when it happened. It was the first time I saw a case like this and it was a very traumatic experience for me. Brian was finally hospitalized for 3 days.
The day before I wrote this letter Brian had a fever again. In the meantime, as I waited for his pediatrician to start his practice in the afternoon, I gave him some fever medicine, which I had saved from Brian's visit 2 months ago.
However, the medicine did not work well (his pediatrician explained later that the dosage had changed because of an increase in his weight and age), and Brian's temperature remained high, at around 38.5 degrees Celsius to 39 degrees Celsius. I panicked when I noticed Brian had a sudden shudder. So I compressed his body with wet towel, which reduced the temperature by 0.3 degrees Celsius to 0.5 degrees Celsius.
I also gave him Stesolid, which I got from his pediatrician before. But I think the Stesolid didn't work either, as it seemed most of it spilled out (also Brian defecated a minute later).
My questions:
1. Is a whole-body cold compress the right thing to use in such a case? Some people suggest that a cold bath can be given also. What is the right thing to do in such a situation?
2. When should Stesolid be given? Can it be administered more that once within 6 hours?
3. Can a seizure occur when a patient is sleeping?
4. Is a sudden shudder a sign of seizure?
5. Can medicine be taken more than once within eight hours? (Normally a doctor will specify that it be taken three times daily, which means at intervals of eight hours.) For example, from the time Brian took the medicine to the time his fever came back was five hours. Waiting for 8 hours before repeating the medicine was certainly very dangerous for him, so I repeated his medicine after six hours. Was that the right thing to do?
6. Brian drinks a lot of water every day (his total intake, including milk, is around 1.5 to two liters). His pediatrician said too much liquid was not good for a baby, but did not explain why.
I would very much appreciate your advice. -- In Cin
Dear In Cin,
Brian has a common condition known as febrile convulsion, which can happen to any child but is more common in children who have a family history, especially from a mom or dad who had the same experience when they were young.
The seizure can range from a small, sudden shudder to a whole- body convulsion. There are two different types: The first is a simple convulsion, lasting for less than five minutes at a time, and can be a generalized seizure, which means the whole body jerks, with no complications after convulsion.
The second is more complex, lasting longer and is a partial form, in which only parts of the body convulse such as an arm or legs, and lasts longer than five minutes.
For your son, he has had seizures twice. I advise you should give him paracetamol every four hours to six hours and in the meantime, if in less than 4 hours he develops a fever again you could use it to combat the fever. Most important of all, when sponging him use warm water: Sponge him with all his clothes off and in areas with many blood vessels such as his neck, armpits, groin and behind the knee; sponge him until he has cooled down and give him plenty of fluid.
By sponging, I mean put a wet towel on his body and use a small towel in warm water to rub his neck back and forth. Change the water and do it until his neck cools down then move to the other areas; as I said, the areas where there are many blood vessels are more effective than the trunk and back.
As for fluids, 1.5 liters to two liters is quite good for a youngster like him; I think as long as his kidneys work fine there is no problem with 2 liters of water.
A diazepam (valium) suppository or tablet three times daily for 48 hours during the fever is recommend as well. In the past we used phenobarbital but it effected the cognitive function in the long run so it is used less; now a short course of valium is preferred.
Please feel free to ask and I will be here to answer. -- Dr. Donya