Are febrile seizures dangerous?

child-with-feverWatching a child have a febrile seizure is one of the scariest things a parent can experience. One minute, the child is acting normal or mildly sick and the next, his eyes roll up, he gets stiff all over, his lips turn blue and his body starts to shake. In most cases, a febrile seizure lasts a minute or less, but it seems much longer to the parent who’s watching it.

Febrile seizures occur in 3 percent of children between 6 months and 5 years. The seizure is triggered by the rapid rise in temperature that accompanies an illness. In some cases, parents don’t even know their child had a fever at the time of the seizure.

After the seizure has stopped, children are typically a bit floppy and “out of it” for a while. They usually start to act like themselves within 5 minutes or so.

About 30 percent of children who have a febrile seizure will have another one. Recurrences usually occur within a year of the first seizure. The younger a child is at the time of his first seizure, the more likely he will have another one.

Febrile seizures are rarely dangerous and children with simple febrile seizures don’t need to be treated with anti-seizure medication because the drugs are more dangerous than the seizures themselves. Children with complicated febrile seizures sometimes needed to be treated with medication. A complicated febrile seizure lasts more than 15 minutes, involves one side of the body or recurs within a 24-hour period.

It’s understandable that parents want to aggressively treat fever after their child has had a febrile seizure. However, research has shown that aggressive fever management does not prevent febrile seizures. The reason parents need to know this fact is because they might otherwise blame themselves, each other or baby sitters because a child had a seizure during an illness.

For more information about febrile seizures, check out the following link:

http://www.ninds.nih.gov/disorders/febrile_seizures/detail_febrile_seizures.htm

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How to take a rectal temperature in newborns

Child-Rectal-ThermometerAfter a baby is born, hospital nurses take armpit temperatures. They do this for two reasons. First, they want to be sure a baby’s temperature doesn’t drop as she adjusts to being outside the uterus. Second, because the nurses take temperatures multiple times per day, they do it in a way that is quicker and less disruptive for the baby.

Once you take your baby home, you should take rectal temperatures if you’re concerned that the baby is sick or has a fever. The reason for this is because rectal temperatures are the most accurate way to check for fever, and a doctor’s diagnostic approach to fever is based on rectal temperatures. Pediatricians define fever in the first three months as a rectal temperature of 100.4 degrees or higher.

It’s much easier to take rectal temperatures on newborns than older infants. There are different ways to do this, but I prefer having a baby lying across my legs with her bottom facing up. I separate her buttocks with one hand and gently insert a lubricated digital thermometer with the other. I insert the tip about ½ inch and hold the thermometer in place with two fingers of the same hand I used to separate the baby’s buttocks. That way I don’t have to worry that the device will poke the baby if she wiggles or moves.

When can kids with hand, foot and mouth syndrome return to school?

Hand Foot Mouth in KidsMost children contract hand, foot and mouth syndrome before kindergarten. The infection is usually caused by a member of the Coxsackie virus family. It typically presents with fever, sore throat and small blisters on the palms and soles. Some strains of the virus also cause a red bumpy rash on the body. The treatment is the same as it is for most viral infections: rest, fluids and fever control.

When I see kids with hand, foot and mouth syndrome, parents usually ask two questions. (1) How long is the child contagious? (2) When can she go back to daycare or school? The answer to the first question surprises parents. They’re contagious for 2 to 3 weeks after they get sick. The answer to the second question surprises them even more. Kids can return to school as soon as they feel better. What? How can doctors send kids back to school when they’re still contagious? The rationale for this is simple. Up to 20% of children with hand, foot and mouth syndrome are asymptomatic. This means they contracted the virus and are spreading it to others even though they’re not sick themselves. That fact, combined with the long contagious period, means keeping kids home will have no impact on the spread of the disease. That’s why we send them back when they feel better.

Is it OK to give kids fever (or other) medicine before a doctor’s visit?

kid's tylonol before doctor visitLots of parents think that giving a child acetaminophen or ibuprofen prior to seeing the doctor will compromise the visit. This is not true. Fever reducing medicine won’t make it harder for the doctor to figure out what’s wrong. In fact, reducing a child’s fever usually makes it easier for the doctor because the child is more likely to cooperate if her temperature is lower during the visit.

The same thing is true for asthma medicine or any other drug your child is taking. Unless the doctor or nurse specifically tells you not to give a medicine before a visit, you should do what you can to control your child’s symptoms.

Why do kids have to be fever-free for 24 hours before returning to school?

Why do kids have to be fever free for 24 hoursBody temperature varies throughout the day whether you’re sick or healthy. If you take your daughter’s temperature three times a day for a number of days, you will see that the highest readings come in the evening. Similarly, if she is sick, you are more likely to find high temperature at 9pm rather than 9am. This diurnal variation in body temperature causes two problems for parents. First, it’s harder to manage high fevers at night when everyone is trying to get some sleep. Second, if your feverish child wakes up cool, you may think all is well until the fever returns in the afternoon or evening. Although it’s not always clear when a child isn’t contagious, most schools have adopted a 24-hour fever free policy because they know temperatures can come back as the day progresses. That’s why you shouldn’t take your kids to school the morning after a feverish night.

Can a teenager be immune to mononucleosis and not know it?

Immune-to-MonoIt’s common knowledge that people are usually diagnosed with mononucleosis (mono) during adolescence. This is the reason it’s often referred to as the “kissing disease.” What lots of people don’t know, however, is that about 20 percent of children get mono before age ten. 

The explanation for this fact lies in the way the human body responds to infections. When a person comes down with an illness, his immune system produces antibodies to help kill the invading microorganism. The first antibodies the body produces are in the IgM class. These antibodies are present for about three months after which they disappear from the circulation.

A month or so after the body starts producing IgM antibodies, it makes IgG antibodies to the same viral or bacterial agent. However, IgG antibodies are produced continuously and will remain in a person’s bloodstream for life. The reason you don’t get the same infection more than once is because IgG antibodies are always around, and they prevent the infection if you are exposed to the virus or bacteria in the future. This is what it means to be “immune” to something.

Antibody production also explains how immunizations work. When you get a vaccine, your body is injected with a tiny amount of a killed or weakened biologic agent. Your body then makes antibodies to that microorganism so if you get exposed to the germ at a later time, you won’t get sick or you will have a milder form of the illness. In most cases, the body’s immune system is superior to vaccinations in terms of conferring future immunity. That’s why vaccines are not 100 percent effective. A notable exception is whopping cough, which is better prevented by vaccines than natural infection.

Okay, back to mononucleosis. When I draw blood to check for mono, I always test for IgM and IgG antibodies to the virus. If the patient’s IgM antibodies are positive, that means he currently has mono. However, if the IgM antibodies are negative, but the IgG antibodies are positive, that means he had mono at some point in the past, but does not have it now, i.e., the current infection is due to another virus. If the patient has a negative test for IgM and IgG antibodies that means he doesn’t have mono now and did not have it in the past either.

Parents almost never recall a preteen child having had mononucleosis because this age group does not get the classic mono symptoms: fever, swollen lymph nodes, horrible sore throat and fatigue. Instead, they usually have a fever that lasts for four or five days.

Fever management for children who can’t (or won’t) take oral medication

In a recent article, I stated that fever does not always need to be treated. In many cases, however, it’s worthwhile to treat fever to help children sleep or prevent them from becoming dehydrated.

There are two situations when parents will have difficulty managing their child’s fever with oral medication. First, if the child is unable to keep the medication down because he is vomiting. Second, if he is being uncooperative and won’t take the medication in the first place.

In general, I don’t use my blog to endorse products. However, parents should know about an over-the-counter medication called FeverAll that will come in handy if their child can’t take acetaminophen by mouth. FeverAll is acetaminophen in suppository form. It’s safe to use and works as well as oral acetaminophen. It is worth having FeverAll in your medicine cabinet in case your child gets sick at night or when it would be difficult to buy the medication on an urgent basis.

FeverAll comes in three doses: 80mg, 120mg and 325 mg. You use the same dose as you would with oral acetaminophen. Directions for inserting suppositories into the rectum are included with the packaging.