Managing Febrile Seizures in Young Children: Key Considerations

1. Examination 2. Medication 3. Temperature issues

A 2-year and 7-month-old girl experienced her first febrile seizure three days after attending kindergarten, following an enterovirus infection (at that time she was 2 years and 5 months old).
She was hospitalized for five days in the emergency department.
Two days after discharge, she had a second febrile seizure and was hospitalized again (this time diagnosed with bronchitis).
The doctor previously mentioned that an electroencephalogram (EEG) should be performed, which was done during her first hospitalization for the febrile seizure (results were normal).
The doctor stated that since the second seizure occurred too soon after the first, there was no need for another EEG.
I would like to know your opinion on the following:
1.
Do I still need to take her to a larger hospital for more detailed examinations?
2.
Since her hospitalization in January, she has been on medication (from a small hospital and pediatric clinic) including antibiotics and steroids, due to persistent cough and runny nose, and occasionally having a fever over 38 degrees Celsius.
Will this affect her physical development? Is it necessary to take medication for a cough?
3.
Her ear temperature usually ranges between 37 to 37.5 degrees Celsius.
Is there a way to lower her temperature to around 35 to 36 degrees Celsius, so that she is less likely to have a high fever leading to febrile seizures? Thank you, doctor.

Ying, 0~9 year old female. Ask Date: 2016/03/11

Dr. Pei Rensheng reply Pediatrics

Hello,
1.
If the child has experienced heat cramps twice, and the EEG is normal with normal development, we can choose to observe.
In the future, if there is a fever, we should manage it actively.

2.
The duration of antibiotic treatment is fixed and depends on the type of infection the child has.
Generally, if the dosage is appropriate, it will not affect growth and development.

3.
If the child has asthma or other allergic conditions, the physician may prescribe steroids.
Typically, continuous use for less than two weeks will not cause side effects.

4.
Cough suppressants and expectorants are symptomatic treatments that can alleviate symptoms.
If there is persistent fever, a medical consultation is still necessary.

5.
An ear temperature of 37.8 degrees Celsius or below is not considered a fever; treatment for fever should be initiated if the temperature exceeds 38 degrees Celsius.

Wishing you health and happiness,
Dr.
Pei Ren-Sheng
Director of Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2016/03/11

More Info

Managing febrile seizures in young children can be a challenging experience for both parents and healthcare providers. Febrile seizures are convulsions that can occur in young children when they experience a rapid increase in body temperature, often due to an infection. In your case, your daughter has experienced two febrile seizures, which understandably raises concerns about her health and development.

1. Further Evaluation: Given that your daughter has had two febrile seizures in a short period, it is reasonable to consider further evaluation. While her EEG results were normal after the first seizure, if her seizures continue or if there are any concerning symptoms, consulting a pediatric neurologist for a more comprehensive assessment may be beneficial. This could include a detailed history, physical examination, and possibly additional imaging studies to rule out any underlying conditions that could predispose her to seizures.

2. Impact of Medication on Development: Regarding the prolonged use of antibiotics and steroids, it is important to weigh the benefits against potential risks. While antibiotics are essential for treating bacterial infections, their overuse can lead to antibiotic resistance and other complications. Steroids, while effective in reducing inflammation, can have side effects, especially with long-term use, including potential impacts on growth and development. It is crucial to discuss with her pediatrician the necessity of ongoing medication and whether alternative treatments might be appropriate. Coughing does not always require medication; sometimes, supportive care such as hydration, humidified air, and rest can be effective. If her cough persists or worsens, a follow-up with her healthcare provider is warranted.

3. Managing Body Temperature: As for managing her baseline body temperature, it is important to understand that normal body temperature can vary among individuals. A typical range is between 36.1°C (97°F) and 37.2°C (99°F). It is not feasible or healthy to artificially lower her temperature to a range that would prevent febrile seizures. Instead, focus on managing fever effectively when it occurs. This can include using fever-reducing medications like acetaminophen or ibuprofen, ensuring she stays hydrated, and dressing her in lightweight clothing. Monitoring her temperature regularly and being proactive in treating fever can help minimize the risk of seizures.

In summary, while febrile seizures can be alarming, they are often benign and do not typically indicate a long-term problem. However, close monitoring and communication with her healthcare providers are essential to ensure her health and development are on track. If you have ongoing concerns about her health, do not hesitate to seek further evaluation or a second opinion. Your vigilance as a parent is crucial in managing her care effectively.

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