Emergency Medicine

364 Paediatric Emergencies

Seizures and Febrile Convulsions

Seizures

Seizures must be distinguished from other causes of brief loss of consciousness,
such as syncope, pallid breath-holding, and cyanotic breath-holding.

DIAGNOSIS

The likely cause of a seizure can be related to the age of the child.

1 Newborn

Seizures tend to be mere twitching of a limb, fluttering of an eyelid or conju-

gate eye deviation. Causes include:

(i) Hypoglycaemia.

(ii) Hypocalcaemia.

(iii) Hypoxia, especially from birth injury.

(iv) Cerebral haemorrhage and subdural haematoma.

(v) Infection.

(vi) Drug withdrawal.

2 Pre-school child

The commonest cause is a febrile convulsion.

Other possibilities include:

(i) Idiopathic epilepsy.

(ii) Meningitis or encephalitis.

(iii) Head injury, including injury from child abuse.

(iv) Dehydration from gastroenteritis etc.

(v) Hypoglycaemia.

(vi) Poisoning.

(vii) Sudden reduction in epilepsy medication.

3 Older child

Causes include:

(i) Idiopathic epilepsy.

(ii) Sudden reduction in epilepsy medication.

(iii) Head injury.

(iv) Meningitis or encephalitis.

(v) Hypoglycaemia.

(vi) Poisoning, including theophylline, iron and tricyclic

antidepressants.

MANAGEMENT

1 Clear the airway, place the child on their side, and give oxygen via a face

mask. Attach electrocardiographic (ECG) monitoring and a pulse oximeter.