Paediatric Acute care Guidelines PMH Emergency Department

Febrile convulsions are seizures in children aged between 6 months and 5 years that result from a sudden rise in temperature associated with an acute febrile illness

Background

  • Febrile convulsions are common in childhood, and are common ED presentations
  • Most are simple febrile convulsions which are benign

Febrile-convulsion-2013.12.11

General

Febrile convulsions occur in 3-5% of children

  • Between 6 months and 5 years
  • 90% occurring between 6 months and 3 years
  • The peak incidence is at 18 months of age
  • Approximately 5% of children with febrile convulsions present with febrile status epilepticus

Febrile convulsions can be divided into Simple and Complex.

Simple Febrile Convulsions: 

  • Duration less than 15 minutes
  • Generalised in nature (not focal)
  • Only 1 seizure in 24 hours
  • Occur in developmentally normal children
  • No neurological abnormalities post seizure

Complex Febrile Convulsions either:

  • Prolonged (> 15 minutes)
  • > 1 seizure in 24 hours
  • Focal in nature

The risk of recurrent febrile convulsions is increased with:

  • Multiple initial seizures (occurs in 10-15% of febrile seizures)
  • < 12 months at first febrile convulsion
  • Low grade temperature at first seizure
  • Family history of febrile seizures
  • Brief duration between fever onset and febrile seizure
  • Developmental delay

Future Risk of Epilepsy:

  • Complex febrile convulsions
  • Family history of epilepsy
  • Any neuro-developmental problem in the child

If one risk factor, chance of epilepsy is 2% (which is double the population risk)
If two or more risk factors, chance of epilepsy is 10%

Risk factors

 

 

Assessment

  • A febrile convulsion can be the presenting complaint of an illness
  • It is important to identify the source of the fever
  • Most children with a simple febrile convulsion require no further investigation
  • Children with complex febrile convulsions may require admission and further investigations

History

  • Afebrile seizure – make sure there is a history of fever at the time of seizure or documented fever in ambulance or ED
  • Determine if the child has had a vaccination in the past 14 days
  • If so, a WAVSS WA Vaccine Safety Surveillance: Adverse Reaction Reporting Form needs to be completed

Investigations

  • Usually no investigations are required for a simple febrile convulsion
  • For complex febrile convulsions consider blood tests, urine, lumbar puncture and CXR

Management

Initial management

  • Ensure high flow oxygen is provided whilst the child has a decreased level of consciousness or is still fitting
  • If the child is still fitting for more than 5 minutes proceed to ED Guideline: Status Epilepticus
  • Treat the underlying cause of fever if appropriate
  • Antipyretics such as paracetamol have not been shown to prevent convulsions but may be worth considering for symptomatic relief of discomfort and pain

Discharge criteria

Children can be discharged who:

  • had a simple febrile convulsions and are fully recovered and parents are happy for discharge
  • have an obvious cause of fever and have been observed in ED for 2 hours post seizure

Discuss all other cases with a Senior ED Doctor regarding the need for admission

Referrals and follow-up

  • For simple febrile convulsions, GP referral in next few days

Health information (for carers)

At discharge provide parents with the following:

Facts For Parents:

  • Approximately 30% of children who have had a febrile convulsion will have a recurrence
  • Of those that have a reoccurrence 50% will occur within the first year, 90% within 2 years

Nursing

  • For seizures in progress commence high flow oxygen and turn the patient on their side
  • See ED guideline: Status epilepticus

Observations

  • Baseline observations include heart rate,respiratory rate and temperature. Blood pressure, oxygen saturations and neurological observations if clinically indicated 
  • Minimum of 1 hourly observations should be recorded whilst in the ED
  • Continuous SpO2 monitoring is required while the patient has a reduced level of consciousness

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