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Definations:
Febrile fits (F.C.) are defined as fits occurring in association with fever in children
between 3 months and 6 years of age, in whom there is no evidence of intracranial
pathology or metabolic derangement that could be the cause of the fit. Febrile fits,
febrile convulsions and febrile convulsions are synonymous terms. Children with
previous afebrile fits are excluded from this definition.
Magnitude of Problem
There is no comprehensive local epidemiological data. Studies in Western Europe
quote a figure of 3-4 % of children 5 years experiencing febrile fits with higher figures
of up to 8% in Japan. This makes febrile fits the single most common problem in
paediatric neurology.
Types of Febrile Fits
Febrile fits are classified as either simple or complex. Simple febrile fits are short, 15
minutes, generalised fits that do not occur more than once in a febrile episode. Febrile
fits that are either prolonged ( 15 mins ) unilateral or recur within a single febrile
episode are classified as complex. (Nelson &Ellenberg,1978)
Issues in management of Febrile Fits.
The major issues are:-
Ellenberg, Verity et al). There was no difference between those who had simple or
complex febrile fit in this respect. Children with F.C. actually had better reading skills is
one study (Verity). Another study showed that those who had experienced complex
febrile fit actually did better academically than those with simple febrile fits, but the
difference was not significant (Knudsen).
D. Need for admission.
Not all children with febrile fits need to be admitted. The main reasons for admission
are:-
F.Type of prophylaxis
There are 3 options
shown in large studies to render this approach ineffective. Often caregivers are not
aware of fever until the child has fitted.
c)
intravenously. If the fits persist or recur after that, then the child should be treated
as a case of status epilepticus.
Midazolam however can be given intramuscularly in doses of 0.3-0.5mg/kg and has
been shown to achieve therapeutic levels in 3 minutes.
a) Parents of children with febrile fits should be counselled on the benign nature of this
condition.
c) The parents should also be advised on first aid measures during a fit, if this was to
recur namely:
i
i)
iii) Place the child in the left lateral position with the head lower than the body.
vi vii) Stay near the child until the fit is over and comfort the child as he/she is
recovering.
vii viii)The caregiver of children with a high risk of recurrence, ie more than 3 risk
factors, should be supplied with a preparation of diazepam rectal solution at 0.5
mg/kg of the childs weight. They should be advised on how to administer this in
case the fit last more than 5 minutes.
ix) Rectal Diazepam solution is a list C item in the Ministry of Healths drug list
and hence should be available in all government health facilities.
viii ix) In the event that the fit is not aborted by rectal diazepan they should seek
urgent medical help to stop the fit before status epileptics develops.
ix x) If the fit is aborted, they should also seek medical advise to determine the cause
of the fever.
These recommendations apply both to children who have had a simple or a complex
febrile fit.
References
Pages 253-275
10.
12.
Members of Panel
Dr Hussain Imam Hj Muhammad Ismail (Chairperson)
Prof Motilal
Prof Ong Lai Choo
Dr Sofiah Ali
Dr Malinee Thambyayah
Prof Zabidi Azhar Hussein
Dr Koh Chong Tuan
Dr Khoo Teck Beng
Comfort child
Seek medical advice on cause of fever
No rectal diazepam
at home
Administer rectal diazepam
Fit stops
medical facility
Comfort child
Administer
rectal
diazepam or
Seek medical advice
Intravenous diazepam or
on cause of fever
Intramuscular
midazolam
Fit stops
Observe child
Fit recurs
Minor illness