5 Benign Febrile Convulsions Nursing Care Plans Posted by NursesLabs on October 11, 2011 A febrile seizure is a convulsion in a child

triggered by a fever. Such convulsions occur without any underlying brain or spinal cord infection or other neurological cause. According to studies, about 3-5% of otherwise healthy children between the ages of 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Most occur well within the first 24 hours of an illness, not necessarily when the fever is highest. The first febrile seizure is one of lifes most frightening moments for parents. Most parents are afraid that their child will die or have brain damage. Thankfully, simple febrile seizures are harmless. There is no evidence that simple febrile seizures cause death, brain damage, mental retardation, a decrease in IQ, or learning difficulties. (www.nlm.com) However, a very small percentage of children go on to develop other seizure disorders such as epilepsy later in life. See all our nursing care plans here 1 Hyperthermia Benign Febrile Convulsion is a convulsion triggered by a rise in body temperature. Fever is not an illness and is an important part of the bodys defense against infection. Antigens or microorganisms cause inflammation and the release of pyrogens which is a substance that induces fever. Assessme Nursing NursingInterventio Expected Planning Rationale nt Diagnosis ns Outcome Subjective Hypertherm Short term: >Assess underlying >To obtain Short term: : ia condition and body baseline After 4 hours of The temperature. date. nursinginterventio patients ns, the patients >Monitor and >To note for temperature temperature will recorded vital signs. progress shall have Objective: decrease from 39C and evaluate decreased to normal range of >Remove effects of from 39C the patient 36.5C to 37C. hyperthermi to normal unnecessary manifested range of clothing that could a. : 36.5C to Long Term: only aggravate heat. 37C. >To > febrile After 2 days of >Promote adequate decrease or temp = totally Long Term: nursinginterventio rest periods. 39C diminish ns, the patient will

>flushed skin and warm to touch > convulsion > RR = 34 bpm the patient may manifest: > high fever > weakness

be able to be free of >Provide TSB complications and maintain core >Advise to increase temperature fluid intake. within normal range. >Loosen clothing.

The patient shall have >Reduces been able to metabolic be free of demands or complicatio ns and oxygen. maintain core >To >Administer IV temperature fluids at prescribed promote within surface rate. Monitor normal cooling. regulation rate range. frequently. >To help decrease >Administer body antipyretics as temperature ordered. . >To provide proper ventilation and promote release of heat through evaporation. >To promote fluid managemen t. > Antipyretics lower core temperature .

pain.

~~~~~~~~~~~~ 2 Imbalanced Nutrition The nutritional requirements of the human body reflect the nutritional intake necessary to maintain optimal body function and to meet the bodys daily energy needs. Malnutrition

(literally, bad nutrition) is defined as inadequate nutrition, and while most people interpret this as undernutrition, falling short of daily nutritional requirements. The etiology of malnutrition includesfactors such as poor food availability and preparation, recurrent infections, and lack of nutritional education. Assessm Nursing Planning ent Diagnosis Subjectiv Imbalance Short term: e: Nutrition: Less After 4 hours of than the body nursingintervent requirement ions, the related to Objective economicalfact patients will identify : ors. measures to promote the nutrition and patient follow the manifeste treatment d: regimen > body Long Term: weakness > weight of 7.9kg > loss of appetite > poor muscle tone the patient may manifest: > abnormal laborator y studies > pallor NursingIntervent Rationale ions >Review patients >To obtain records. baseline data. >Assess underlying condition. Expected Outcome Short term:

>To determine The specificintervent patient ions. shall have identified measures >discuss eating >To achieve habits and health needs of to promote encourage diet for the patient with nutrition age. the proper food and follow the diet for his treatment > Note total daily disease. regimen. intake includes patterns and time >To reveal Long of eating. change that After 2 days of should be made Term: nursingintervent >Consult in the clients ions, the will dietary intake. The physician for demonstrate patient further behaviours or shall have assessment and >For greater lifestyle changes recommendation understanding demonstra to regain ted regarding food and further appropriate behaviours preferences and assessment of weight. or lifestyle nutritional specific food. changes to support. regain appropriat e weight.

~~~~~~~~~~~~ 3 Ineffective Tissue Perfusion The circulation to the tissues is not getting enough oxygen or nourishment. Decrease in oxygen resulting in the failure to nourish the tissues at the capillary level. Nursing Planning Diagnosis Subjective: Ineffective Short term: tissue After 4 hours perfusion of nursing realated to Objective: decreased intervention, the patient Hgb The patient concentratio will manifested: n in blood as demonstrate behaviour evidenced by lifestyle >Body low Hgb temperature count in CBC changes to improve changes. result circulation. >Skin Long term: discoloratio n After 2 days of nursing The patient intervention, may the patients manifest: S.O. will verbalize > Anemia understandin g of the condition. Assessment NursingInterventions Rationale > Establish rapport. Expected Outcome Short term:

> To gain patient and > Monitor VS. The patient S.O.s trust shall have and demonstrate > promote Determinefactors relate cooperation d behaviour lifestyle d to individual . change. situation. > To Long term: > Evaluate for signs of monitor patients infection especially when immune system is status. The patients compromised. S.O. shall > To gain have information verbalized > Discuss individual regarding understandin riskfactors. the g of the > Elevate head of bed at condition. condition. night. >To observe for > Discuss the importance of a healthy possible risk factors. diet.. > This information would be necessary for the clients S.O. > To increase gravitationa l blood flow.

>To promote a healthy diet to help increase RBC synthesis and Hgb count for faster recovery. ~~~~~~~~~~~~ 4 Risk for Infection The immune system is the bodys defense against bacteria, viruses, and other foreign organisms or harmful chemicals. It is very complex and it has to work properly to protect us from the harmful bacteria and other organisms in the environment which may infect our body. If the immune system is compromised, it can affect the normal production of WBC from the bone marrow. If there is an increase in number of WBC, therefore it may increase the possibility to increase infection. Nursing Assessme NursingInterventi Diagnos Planning nt ons is S= Risk for >Establish good Short Term: (spread) working O = the of relationship with patient infection After 3 hours of the client and S.O. manifested nursinginterventio : ns, the patient will >Monitor and record vital signs verbalize >body understanding of weakness ways on how to > Determine pts prevent spread of individual strength infection. >fatigue >Provide peaceful Long Term: environment >poor muscle tone After 1week of >Provide adequate nursinginterventio rest and sleep. ns, the patient will =The be free from patient >Emphasize infections and may importance of hand Rationale Expected Outcome

>To gain Short Term: their trust and cooperatio After 3 hours of nursinginterventio n ns, the patient >For shall have comparati verbalized ve understanding of baseline ways on how to data prevent spread of infection. >To know when to Long Term: assist client After 1week of nursing >To interventions, the promote patient shall have

manifest: >elevated body temperatu re >Hgb = 112 >WBC = 22.9 >RBC = 3.97 >HCT = 0.34 >Platelet count = 234

further complications

washing >Provide safety measures >Monitor I & O >Check IV and Regulate IVF >Advice pt to increase oral fluid intake when allowed

optimum level of functionin g >To prevent fatigue and conserve energy >.to prevent occurrenc e of further infections >To prevent falls and injuries >To note for imbalance s >To ensure proper hydration > To replace fluid electrolyte loss

been free from infections and further complications.

~~~~~~~~~~~~ 5 Risk for Injury

A seizure or convulsion is the visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes, such as a high fever and lack of oxygen. Hemoglobin is a protein in red blood cells that carries oxygen. Therefore, Low levels of hemoglobin in the human body may reult to seizure. During episodes of convulsion, patients are prone to injuries since they may strike different objects due to uncontrollable muscle spasms. Assessmen Nursing Nursing Planning t Diagnosis Interventions Subjective: Risk for Short term: >establish rapport injury After 4 hours >monitor and record related to of nursing Vital Signs possible interventions, Objective: convulsion the SO will > ascertain knwlge of . modify safety needs/ injury the patient environment prevention may as indicated to manifest the enhance following: > note clients gender, safety. age, developmnt stage, decision makng >Fever Long term: ability, level of cognition/competenc >Convulsion After 2 days of e nursing >Low interventions, >provide health care the SO will within a culture of >Low Hgb verbalize safety Level = 112 understandin g of individual > identify factors that interventions/safety contribute to devices possibility of injury. > discuss importance of self monitoring of conditions/ emotions Rationale > To gain patients trust Expected Outcome Short term:

The SO shall >To obtain have modified baseline data environment as indicated to > to prevent enhance safety. injuries in home, community, Long term: and work setting The SO shall have >affects verbalized clients ability understandin to protect g of individual self/others factors that and influence contribute to choice of possibility of interventions injury. / teachings >to prevent errors resulting in client injury, promote client safety and model safety behaviors for client/SO >to promote safe physical environment

and individual safety >it can contribute to occurence of injury

Febrile Convulsions

Seizure: A clinical event in which there is a sudden disturbance of neurological function in association with an abnormal or excessive neuronal discharge. (Lissauer, 2002). A febrile convulsion is a seizure occurring in a child aged from six months to five years, precipitated by a fever arising from infection outside the nervous system in a child who is otherwise neurologically normal. Febrile convulsions have long been recognised, but only in recent years more fully understood. Hippocrates, writing in the 4th century BC, described such a convulsion, clearly differentiating it from rigors and breath holding attacks. He noted that both generalised and partial seizures can occur, and realised that there was a strong association with age, high fever and a precipitating infection. (Great Ormond Street Hospital for Children NHS Trust).

Febrile convulsions are a common paediatric presentation to A&E departments, occurring in about 3% of children between the ages of six months and five years. The seizure usually occurs early on in a viral infection when the temperature is rising rapidly, and typically lasts less than five minutes. It is the abrupt rise in temperature rather than the high level that is important. The seizures are tonic or tonic-clonic, with loss of consciousness and muscular rigidity forming the tonic stage. This may be preceded by a frightened cry from the child. Cessation of respiratory movements and incontinence of urine and faeces may occur during this stage, which lasts about 30 seconds. The clonic stage that follows is characterised by repetitive movements of the limbs and face.

Management of the fitting febrile child:

Clothing should be removed and the child covered with a sheet. The child should be placed on its side, or prone with its head to one side, since vomiting with aspiration is a hazard. Rectal diazepam is the drug of choice, producing an effective blood concentration of anticonvulsant within ten minutes. All children with a first febrile convulsion should be admitted to hospital to a) exclude meningitis and b) educate the parents. A urine specimen should be taken to exclude infection, and a blood glucose level should be taken. A lumbar puncture may be performed if the child is less than eighteen months old shows signs of meningitis or sepsis.

Treatment of the febrile child: Fever should be treated to promote the comfort of the child and to prevent dehydration. Paracetamol is the preferred anti-pyretic and fluid levels should be maintained. Ibuprofen can be given if the fever does not respond to paracetamol. Rectal diazepam should be administered as soon as possible after the start of the convulsion, and should not be given after the convulsion has stopped.

Information should be supplied by the hospital to parents, explaining the nature of febrile convulsions, including information about the prevalence and prognosis. Parents should be instructed on the management of fever, the management of a convulsion and the administration of rectal diazepam. Finally, they should be reassured. During further febrile illnesses, parents should be advised to keep the childs temperature low, by removing warm clothing, tepid sponging and giving an antipyretic (paracetamol or ibuprofen) such as Calpol. Parents of children with an increased risk of seizure recurrence should be supplied with rectal diazepam to administer for any further seizure lasting more than five minutes. Parents should receive written as well as verbal advice on the first aid management of a further convulsion. Following convulsion, a doctor should always be consulted in order to determine that the cause is simply a viral infection, and not something more serious such as meningitis.

The overall risk of a further febrile convulsion is one in three, but the recurrence risk is higher if the first seizure occurs before one year of age and there is a positive family history. There is also a greater risk of recurrence if the first convulsion occurs at a relatively low body temperature, below 39C. The chance of having another febrile convulsion in the following year is 30%. The risk of a second fit reduces every year and it

becomes extremely rare after the child turns 6 years old. (NSW Health). A history of febrile convulsions in a first degree relative is associated with a recurrence risk of about 50%. If either parent suffered a febrile convulsion as a child, the risk of the child suffering one rises 10 to 20 per cent. If both parents and their child have at some point suffered a febrile convulsion, the risk of another child getting it rises 20 to 30 per cent. (Netdoctor). It is rare for any child to suffer recurrent febrile convulsions after the age of four years. One in a thousand children may suffer a febrile convulsion after receiving the MMR vaccine. In these cases it occurs 8 to 10 days after the vaccination and is caused by the measles component of the vaccine. However, this causes only about one tenth of cases of febrile convulsion compared with measles itself. (Netdoctor). Children who are prone to febrile convulsions should follow the same programme of vaccination as all other children. A family history of epilepsy is also associated with an increase in the risk of further febrile convulsions. It must be pointed out though that febrile convulsions are not epileptic fits. Febrile convulsions usually have a benign prognosis, but approximately 1% will go on to develop epilepsy in later life. Risk factors for the subsequent development of partial epilepsy are a prolonged seizure (longer than 30 minutes) or if seizures recur within the same illness. References Lissauer, T. & Clayden, G., Illustrated Textbook of Paediatrics, (Second Edition). Elsevier Science Ltd 2002. Febrile seizure A febrile seizure, also known as a fever fit or febrile convulsion, is a convulsion associated with a significant rise in body temperature. They most commonly occur in children between the ages of 6 months and 6 years and are twice as common in boys as in girls.[1][2] Causes The direct cause of a febrile seizure is not known; however, it is normally precipitated by a recent upper respiratory infection or gastroenteritis. A febrile seizure is the effect of a sudden rise in temperature (>39C/102F) rather than a fever that has been present for a prolonged length of time.[2] As well as this, parents caring for children who may be febrile, wrap them up in warm blankets in an attempt to comfort the child, unknowingly increasing their fever and therefore the problem. Febrile seizures occurring in children between the ages of 6 months and about 6 years can be due to a hypersensitive hypothalamus in the brain. The hypothalamus is responsible for homeostatic core temperature regulation, (amongst other factors) and in younger children

it is still a developing portion of the brain, meaning it is susceptible to hypersensitive reactions to slight raises in body temperature. Febrile seizures represent the meeting point between a low seizure threshold (genetically and age-determined; some children have a greater tendency to have seizures under certain circumstances) and a trigger, which is fever. The genetic causes of febrile seizures are still being researched. Some mutations that cause a neuronal hyperexcitability (and could be responsible for febrile seizures) have already been discovered.[citation needed] Several genetic associations have been identified.[3] These include: Type OMIM Gene

FEB3A 604403 SCN1A

FEB3B 604403 SCN9A

FEB4

604352 GPR98

FEB8

611277 GABRG2

Certain forms are considered channelopathies.[4] [edit]Diagnosis The diagnosis is one that must be arrived at by eliminating more serious causes of seizure and fever: in particular, meningitis and encephalitis must be considered. However, in locales in which children are immunized for pneumococcal and Haemophilus influenzae, the prevalence of bacterial meningitis is low. If a child has recovered and is acting normally, bacterial meningitis is very unlikely. The diagnosis of a febrile seizure should not prevent evaluation of the child for source of fever, although this is usually limited to evaluation of the urine in the younger age groups. [edit]Types There are two types of febrile seizures.

A simple febrile seizure is one in which the seizure lasts less than 15 minutes (usually much less than this), does not recur in 24 hours, and involves the entire body (classically a generalizedtonic-clonic seizure).

A complex febrile seizure is characterized by longer duration, recurrence, or focus on only part of the body.

The simple seizure represents the majority of cases and is considered to be less of a cause for concern than the complex.[citation needed] Simple febrile seizures do not cause permanent brain injury; do not tend to recur frequently (children tend to outgrow them); and do not make the development of adult epilepsy significantly more likely (about 35%), compared with the general public (1%).[5] Children with [6] febrile convulsions are more likely to suffer from a febrile epileptic attacks in the future if they have a complex febrile seizure, afamily history of a febrile convulsions in first-degree relatives (a parent or sibling), or a preconvulsion history of abnormal neurological signs or developmental delay. There is an 80% chance that children who have complex febrile seizures will have seizures later on in life. Similarly, the prognosis after a simple febrile seizure is excellent, whereas an increased risk of death has been shown for complex febrile seizures, partly related to underlying conditions.[7] [edit]Symptoms During simple febrile seizures, the body will become stiff and the arms and legs will begin twitching. The patient loses consciousness, although their eyes remain open. Breathing can be irregular. They may become incontinent (wet or soil themselves); they may also vomit or have increased secretions (foam at the mouth). The seizure normally lasts for less than five minutes.[8] [edit]Treatment The vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences. The best way to manage is to control the temperature with acetaminophen (Paracetamol) or by sponging. When anticonvulsant therapy is judged by a doctor to be indicated, anticonvulsants can be prescribed. Sodium valproate or clonazepam are active against febrile seizures, with sodium valproate showing superiority over clonazepam.[9] Febrile Convulsion

See also: Convulsions and Febrile Child guidelines The approach to febrile convulsions requires dealing with - the convulsion - the illness causing the fever. Background to condition: Convulsions, in a child between 6 months and 6 years of age, in the setting of an acute febrile illness, without previous afebrile seizures, significant prior neurological abnormality, and no CNS infection. They occur in 3% of health children are normally associated with simple viral infection are benign Simple febrile convulsions: These are generalised, tonic-clonic seizures lasting less than 15 minutes that do not recur within the same febrile illness.

Complex febrile convulsions: These have one or more of the following: - focal features at onset or during the seizure - Duration of more than 15 minutes - Recurrence within the same febrile illness - Incomplete recovery within 1 hour. Febrile status epilepticus This is a febrile convulsion lasting for longer than 30 minutes. Note: It is now recognised that some children can have a presentation with convulsions and an acute infectious illness (particularly gastroenteritis) without documented fever. This is sometimes referred to as " afebrile febrile convulsions". The management and prognosis is the same as for classical febrile convulsions. Acute Management: Treat the convulsion when necessary as per Convulsions guidelines. * Reassurance is important in simple febrile convulsions. The onset of the convulsion may be sudden with little evidence of preceding illness. The convulsion may be terrifying for the

parents to observe they frequently believe that their child is dying and may attempt CPR or other resuscitative measures. Fever control

Paracetamol has NOT been shown to reduce the risk of further febrile convulsions. It may be used for pain / discomfort associated with febrile illnesses such as otitis media. The parents should understand the reasons for its use and be discouraged from using it solely to reduce their child's fever.

Assessment: In a simple febrile convulsion once the convulsion has terminated, the aim of the assessment is to determine the cause of the fever. History and Examination as per Febrile Child guidelines. In addition, look for the following risk factors which make simple febrile convulsion unlikely: - previous afebrile seizures - progressive neurological conditions - signs of CNS infection Investigations: In a simple febrile convulsion, where the focus of infection can be identified, blood tests and invasive investigations are often NOT indicated. In a child less than 6 months of age reconsider your diagnosis, especially the possibility of CNS infection (meningitis guideline). Consider LP if the child is less than 12 months and not up to date with immunisations (especially Hib and pneumococcal), if they are clinically unwell, or if they are already on oral antibiotics that may mask meningitis. Discuss these children with a senior clinician. If there is a genuine contraindication then antibiotic cover appropriate for meningitis should be commenced. Consider consultation with local paediatric team when: - Complex febrile convulsion. - Seizures unable to be controlled. - Child does not return to normal mental state within 1 hour - Child clinically unwell. - Ongoing concern regarding the nature of the febrile illness. (febrile child guideline) Consider transfer when: - Respiratory or haemodynamic compromise. - Children requiring care above the level of comfort of the local hospital.

For ICU level transfer ring the NETS/PETS Hotline: (03) 9345 7007 Discharge requirements: - Return to normal neurological state following simple febrile convulsion - Serious bacterial infection excluded or adequately treated - Parental education regarding febrile convulsions If discharging a patient home following a febrile convulsion, it is important to give the family advice regarding what to do in the event of a future convulsion. - Verbal advice should be reinforced with written advice (give Parent Information Sheet see below). - Follow-up during as appropriate for the underlying illness. Parent information sheet: Information Specific to RCH If admitted, children with a febrile convulsion are usually admitted under the General Paediatric Team. Discuss with consultant or senior registrar children with complex febrile convulsions or those in whom LP is being considered. Additional Notes Long term issues with febrile convulsions.

Recurrence rate depends on the age of the child; the younger the child at the time of the initial convulsion, the greater the risk a further febrile convulsion (1 year old 50%; 2 years old 30%). Risk of future afebrile convulsions (epilepsy) is increased by family history of epilepsy, any neurodevelopmental problem, atypical febrile convulsions (prolonged or focal). No risk factors: risk of subsequent epilepsy approx. 1% (similar to population risk). 1 risk factor: 2%. More than 1 risk factor: 10%. Long term anticonvulsants are not indicated except in rare situations with frequent recurrences. It may be appropriate to offer a review appointment with a general paediatrician, especially in the case of complex febrile convulsions.

Pathophysiology
Febrile seizures are dependent upon a threshold temperature or the height of the body temperature. [14] [20] [21] The rate of body temperature rise as a cause is a frequently held theory, but this is

unsupported by more recent laboratory and clinical studies. [22] A specific neurotropism or CNS-invasive property of certain viruses (e.g., human herpesvirus-6 (HHV-6), influenza A), and bacterial neurotoxin (Shigella dysenteriae) has been implicated, but the evidence is inconclusive. [13] [16] In some cases, HHV-6 may invade the brain during the acute viraemic phase of exanthem subitum. Exanthem subitum, otherwise known as roseola or sixth disease, is a febrile illness often accompanied by a rash, lymphadenopathy, and GI or respiratory symptoms. Seizure recurrence may be associated with reactivation of the HHV-6 virus. The definition of febrile seizure may need to be modified to include a mild encephalitis or encephalopathy in these cases. The type - simple or complex - may be related to a viral neurotropism or to the severity of a cytokine immune response to infection

Background
Febrile seizures are the most common seizure disorder in childhood. Since early in the 20th century, people have debated about whether these children would benefit from daily anticonvulsant therapy. Epidemiologic studies have led to the division of febrile seizures into 3 groups, as follows: simple febrile seizures, complex febrile seizures, and symptomatic febrile seizures.

Simple febrile seizure

The setting is fever in a child aged 6 months to 5 years. The single seizure is generalized and lasts less than 15 minutes. The child is otherwise neurologically healthy and without neurological abnormality by examination or by developmental history. Fever (and seizure) is not caused by meningitis, encephalitis, or other illness affecting the brain.

Complex febrile seizure

Age, neurological status before the illness, and fever are the same as for simple febrile seizure. This seizure is either focal or prolonged (ie, >15 min), or multiple seizures occur in close succession.

Symptomatic febrile seizure

Age and fever are the same as for simple febrile seizure. The child has a preexisting neurological abnormality or acute illness.

Pathophysiology
This is a unique form of epilepsy that occurs in early childhood and only in association with an elevation of temperature. The underlying pathophysiology is unknown, but genetic predisposition clearly contributes to the occurrence of this disorder.[1]

Epidemiology
Frequency
United States Febrile seizures occur in 2-5% of children aged 6 months to 5 years in industrialized countries. Among children with febrile seizures, about 70-75% have only simple febrile seizures, another 20-25% have complex febrile seizures, and about 5% have symptomatic febrile seizures.

Mortality/Morbidity
Children with a previous simple febrile seizure are at increased risk of recurrent febrile seizures; this occurs in approximately one third of cases. Children younger than 12 months at the time of their first simple febrile seizure have a 50% probability of having a second seizure. After 12 months, the probability decreases to 30%. Children who have simple febrile seizures are at an increased risk for epilepsy. The rate of epilepsy by age 25 years is approximately 2.4%, which is about twice the risk in the general population. The literature does not support the hypothesis that simple febrile seizures lower intelligence (ie, cause a learning disability) or are associated with increased mortality[2] .

Sex
Males have a slightly (but definite) higher incidence of febrile seizures.

Age
Simple febrile seizures occur most commonly in children aged 6 months to 5 years.

History
Children with simple febrile seizures are neurologically and developmentally healthy before and after the seizure. They do not experience a seizure in the absence of fever. The seizure is described as either a generalized clonic or a generalized tonic-clonic seizure. Signs of a focal seizure during the onset or in the postictal period (eg, initial clonic movements of 1 limb or of the limbs on 1 side, a weak limb postictally) would rule out a simple febrile seizure. Similarly, simple febrile seizure activity does not continue for more than 15 minutes, although a postictal period of sleepiness or confusion can extend beyond the 15-minute maximum. Simple febrile seizures often occur with the initial temperature elevation at the onset of illness. The seizure may be the first indication that the child is ill. While no clear cutoff is known, a rectal temperature under 38C should raise concern that the event was not a simple febrile seizure.

Physical
Physical examination findings reveal a neurologically and developmentally healthy child. It is especially important that the child have no signs of meningitis or encephalitis (eg, stiff neck or persistent mental status changes).

Causes
Simple febrile seizures are considered a genetic disorder, but neither a specific locus nor a specific pattern of inheritance has been described. The mode of inheritance is likely to vary between families and may be multifactorial.

Differentials
Acute Disseminated Encephalomyelitis Acute Stroke Management Anterior Circulation Stroke Aseptic Meningitis Basilar Artery Thrombosis Benign Childhood Epilepsy Complex Partial Seizures First Seizure: Pediatric Perspective

Meningococcal Meningitis Neonatal Meningitis Neonatal Seizures Partial Epilepsies Posterior Cerebral Artery Stroke Seizures and Epilepsy: Overview and Classification Simple Partial Seizures Tonic-Clonic Seizures Viral Encephalitis Viral Meningitis

Laboratory Studies
No specific studies are indicated for a simple febrile seizure. Physicians should focus on diagnosing the cause of fever. Other laboratory tests may be indicated by the nature of the underlying febrile illness. For example, a child with severe diarrhea may benefit from blood studies for electrolytes.

Imaging Studies
Neither computed tomography (CT) nor magnetic resonance imaging (MRI) is indicated in patients with simple febrile seizures.

Other Tests
EEG is not indicated in children with simple febrile seizures. Published studies demonstrate that the vast majority of these children have a normal EEG. In addition, some of those with an abnormal EEG have remained free of seizures for the duration of their follow-up. On the other hand, some of the children with a normal initial EEG have experienced 1 or more afebrile seizures subsequent to the EEG. Finally, no evidence indicates that beginning anticonvulsant therapy for a child with simple febrile seizures and an abnormal EEG will alter the child's eventual outcome.

Procedures
Strongly consider lumbar puncture in children younger than 12 months, because the signs and symptoms of bacterial meningitis may be minimal or absent in this age group. Lumbar puncture should be considered in children aged 12-18 months, because clinical signs and symptoms of bacterial meningitis may be subtle in this age group. In children older than 18 months, the decision to perform lumbar puncture rests on the clinical suspicion of meningitis.

Medical Care
On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures. Continuous therapy with phenobarbital or valproate decreases the occurrence of subsequent febrile seizures. o Both therapies confer significant risks and potential adverse effects, whereas additional simple febrile seizures have no proven risk. o These medications are not recommended, since the potential benefits do not outweigh the potential risks. No evidence suggests that any therapy administered after a first simple seizure will reduce the risk of a subsequent afebrile seizure or the risk of recurrent afebrile seizures (ie, epilepsy).

Oral diazepam can reduce the risk of subsequent febrile seizures. Because it is intermittent, this therapy probably has the fewest adverse effects. If preventing subsequent febrile seizures is essential, this would be the treatment of choice.[3] Although it does not prevent simple febrile seizures, antipyretic therapy is desirable for other reasons.

Medication Summary
On the basis of risk/benefit analysis, neither long-term nor intermittent anticonvulsant therapy is indicated for children who have experienced 1 or more simple febrile seizures. In unusual circumstances, oral diazepam can be given with each fever.