366 Paediatric Emergencies
SEIZURES AND FEBRILE CONVULSIONS5 Request a CXR, FBC and urinalysis.
(i) Consider the need for a lumbar puncture with a senior doctor,
when no focus of infection is identified, or in a child
<6 months of age, or an older child with prolonged febrile
seizures.MANAGEMENT1 Manage the convulsion:
(i) Most convulsions are brief and do not require any specific
treatment.
(ii) Position the child on their side, ensure a patent airway and use
oropharyngeal suction if required.
(iii) Apply oxygen via face mask if the child is cyanosed.
(iv) Manage as for generalized seizures if the seizure lasts >5 min or is
associated with focal neurology (see p. 365).
2 Treat the fever:
(i) Undress the child and reduce clothing to a minimum.
(ii) Administer an antipyretic analgesic such as paracetamol 15 mg/
kg orally or as a suppository, or ibuprofen 10 mg/kg:
(a) however, the use of paracetamol has not been shown to
prevent febrile convulsions.
(iii) Treat appropriately if a focus is identified.
(iv) Investigate and treat as for ‘fever without a focus’ if no focus can
be identified (see p. 363).
3 Consider other diagnoses if the child remains unwell or has an incomplete
recovery, residual focal neurology or prolonged or multiple seizures.
4 Advise parents that:
(i) A repeat febrile convulsion will occur in 10–15% of children
during the same illness.
(ii) The risk of developing further febrile convulsions during
childhood is greater with younger children:
(a) the risk is 50% in a 1 year old
(b) the risk is 30% in a 2 year old.
(iii) Anticonvulsant treatment is not required.
(iv) The potential for developing epilepsy is the same as in the general
population (1%), unless risk factors are present such as a family
history of epilepsy, atypical or prolonged febrile convulsion, or
neurodevelopmental problems
(a) there is a 2% risk of epilepsy, if the child has one of these risk
factors, and 10% with two or more risk factors.