Scenario 3

Emily is treated with IV cefotaxime for 48 hours until blood cultures are confirmed negative. A nasopharyngeal aspirate subsequently confirms influenza A.

Question 08

What is the recurrence risk of a simple febrile convulsion in a 2 year old? Which one of the following is the best answer:
1%
5%
30%
50%
80%
Check answer

Explanation

Recurrence rate depends on the age of the child. The younger the child, the greater the risk of subsequent febrile convulsions. A one year old has a 50% risk of recurrence. A two year old has a 30% risk of recurrence. In general, there is approximately 30% risk of having a further febrile convulsion in the next year, with risk reducing every year. Febrile convulsions are rare after age six.

Question 09

What is the risk of epilepsy in a child following a simple febrile convulsion with no other risk factors?
1%
5%
10%
20%
30%
Check answer

Explanation

In a child with no risk factors, the risk of subsequent epilepsy is approximately 1%, which is similar to the risk in the general population. Risk of future non-febrile convulsions is increased by:

  • family history of epilepsy
  • any neurodevelopmental problem
  • atypical febrile convulsions (prolonged or focal)

The presence of one risk factor increases the risk to 2%. More than one risk factor increases the risk to 10%. Emily had both a prolonged and focal seizure, which would therefore increase her epilepsy risk to around 10%. This will increase if she has an abnormal EEG.

Long term anticonvulsants are not indicated except in rare situations with frequent occurrences. Follow up with a paediatrician may be warranted depending on parental anxiety or in the case of an atypical febrile convulsion.

Question 10

What is the most important piece of initial advice you would give Emily’s parents regarding seizure management in the future? Which one of the following is the best answer:
Call an ambulance
Lie Emily on her side in a coma position
Attempt to clear Emily’s airway with their finger
Give paracetamol
Give buccal midazolam
Check answer

Explanation

Obstruction of the airway is a major cause of death and morbidity associated with seizures. Parents need to be taught to place the child in a position of safety lying on their side so the airway is kept clear. They should never place anything in the mouth of a child having a seizure as this may damage the child’s teeth or airway (or injure the parent’s fingers).

It is useful to subsequent management if the parents can record when the seizure started. In parents who are not confident with managing seizures, it is good advice for them to call an ambulance, but not until they have positioned the child. They should definitely call an ambulance if the seizure lasts longer than five minutes. In children who have had prolonged seizures requiring medical intervention, consideration is given to them having a dose of buccal midazolam available.

This is particularly important if the child is far from a hospital but does depend on the parents’ ability to give the medication. Paracetamol is generally advised to be given when a child has a fever. However, it is thought most febrile convulsions are a result of a rapid rise in fever and thus paracetamol generally will not have a chance to take effect to prevent a seizure. It is not first line in seizure management, but part of overall care and comfort of the child.

Reference:

Febrile convulsion factsheet, developed by The Children’s Hospital at Westmead, Sydney Children’s Hospital, Randwick & Kaleidoscope Hunter Children’s Health Network 2005 – 2011
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