Emergency Medicine

Paediatric Emergencies 365

SEIZURES AND FEBRILE CONVULSIONS

2 Check for hypoglycaemia using a blood-glucose test strip. Give 10% dextrose
5 mL/kg i.v. if the reading is low, and send blood for formal laboratory evalu-
ation.

3 If the child has a further seizure or the seizure continues for up to 5 min:
(i) Gain access and give midazolam 0.05–0.1 mg/kg i.v. or i.o.,
diazepam 0.1–0.2 mg/kg i.v. or i.o. at 1 mg/min up to a maximum
of 0.5 mg/kg or lorazepam 0.1 mg/kg i.v. or i.o.
(a) monitor carefully for respiratory depression and record
oxygen saturations every 2–5 min.
(ii) Give additional agents if seizures recur. Respiratory support may
be needed and cardiac monitoring is essential:
(a) phenytoin 15–18 mg/kg i.v. at no faster than 1 mg/kg
per min, provided the child is not on oral phenytoin. Or:
(b) phenobarbitone (phenobarbital) 15–20 mg/kg i.v. over
20 min if already on oral phenytoin.
(iii) Give midazolam 0.5 mg/kg by the buccal route or rectal diazepam
0.5 mg/kg, if access is impossible.

4 Refer all children with a seizure to the paediatric team for further investiga-
tion. Admit children who have not fully recovered from the seizure or have
focal neurological signs.

5 Advise parents that a child allowed home should be supervised when
bathing, swimming, riding a bike and climbing trees until fully assessed and
stabilized as an outpatient.

FEBRILE CONVULSION

DIAGNOSIS

1 These are common and occur in 2–5% of healthy pre-school children. They
are benign with minimal morbidity and are usually associated with a viral
infection.

2 Features that are consistent with the diagnosis of a febrile convulsion include:
(i) Age between 6 months and 6 years.
(ii) Brief generalized convulsion, <10 min in duration.
(iii) Febrile child (temperature >38°C) with a prodromal illness.
(iv) No focal neurological deficit or residual weakness such as a
Todd’s palsy.
(v) No signs of meningitis or encephalitis.

3 Do not label the episode a ‘febrile convulsion’, when the features differ from
those above i.e. a prolonged seizure with focal neurology.

4 The child will appear well following a simple febrile convulsion. Focus the
examination on looking for the source of the fever, including in the throat,
ears, chest, abdomen, urine, skin, etc.