The focus for the infection and fever is the viral upper respiratory tract infection. Febrile seizures tend to occur due to a rapid rise in body temperature.
The ED physician telephones Felix's local doctor, who also speaks Tagalog. Information sheets regarding febrile convulsion in English are given to David; none is available in Tagalog. A letter is written for the local doctor detailing your findings and a brief letter is written to Felix's long day care centre to explain what has happened, enclosing a febrile convulsion fact sheet. David is encouraged to keep the centre informed of Felix's progress.
The explanation about febrile convulsions will need to be repeated and the parents' understanding verified by the local doctor as there is a 30% risk of a further febrile seizure before the age of 5 years. How the parents and carers should manage any seizure should be clarified with them, working on the principle they keep Felix safe. With any further seizures, other causes will still need to be considered. Advice about when to call an ambulance and how to position the child in the event of a future seizure must be given prior to discharge.
It was important to observe Felix to be certain of the origin of his fever. In other children with fever, the origin may not be as obvious and investigations such as lumbar puncture, blood count, blood cultures, urine microscopy and culture or chest X-ray may be appropriate. Following a complicated febrile seizure, there will be other appropriate investigations, such as cerebral imaging.
Antipyretic measures do not have a prophylactic effect on febrile seizures and should be used as comfort measures only.
It is important to teach or revise Felix's parents' first aid in case there is another seizure. It is also important to clarify the first aid knowledge of the staff at the childcare centre and anyone else regularly caring for Felix.
In recent years, there has been much discussion about the types and value of different measures to prevent recurrence of seizures. There is a role for rectal diazepam or buccal midazolam in very frequent or recurrent prolonged febrile seizures or in children who live in remote settings where there would be significant delays in getting help.
Two weeks later, when reviewed by the local doctor, Felix has recovered from his viral URTI and has had no further fever or seizures. His development is not affected and he has begun to use frequent two word utterances in English and Tagalog.
Loyola University Medical Education Network: Seizure Disorders In Childhood
Kilham H, Alexander S, Wood N & Isaacs D (2009) 'Febrile Convulsions' in The Children's Hospital at Westmead Handbook, pp 219 – 221, McGraw Hill: Sydney.
NSW Health basic clinical practice guidelines: Children and Infants with Seizures - Acute Management
Loyola University Medical Education Network: Seizure Disorders In Childhood
Stage 1 and 2 resources on Compass:
Lecture: Seizure disorders – Stage 2, block 2, week 2; PBL: Jason and Brooke
Learning topic: Seizures - Stage 1, block 2, week 1; PBL: Just coping