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Children And Fevers: What Parents Should Know

The more a parent knows about a child's special health needs, the more effective he or she will be when responding to an illness or emergency. To help you prepare for a fever, here's some information from the American College of Emergency Physicians.
Q. Should the parent of a young child be concerned about frequent fevers?
A. Believe it or not, fever in itself is not an illness. In fact, elevated body temperature is one of the body's ways of fighting infection. Fever is one of the most common reasons for parents to visit a pediatrician with their child. Children tend to have an average of nine upper respiratory tract infections a year that include fevers, and children in day-care or preschool tend to have more.
(For children, fever is defined as a rectal temperature of 100.4 degrees Fahrenheit or an oral temperature above 99.5� F.)
"Fever itself is rarely a problem," "However it is a sign that infection may be present. Therefore, when a child has a fever, the focus should be on the child, and the possible infection, and not the reading on the thermometer." However, contact a physician for any fevered child who:
Is under two months of age, because infants don't have well-developed immune systems and could have serious infections.
Has a fever higher than 102� F.
Looks very sick, is poorly responsive and uninterested in his or her surroundings, is sluggish and won't suck on breast or bottle.
Cries constantly, continuously, or without relief.
Is difficult to awaken.
Has a stiff neck.
Has purple spots on the skin.
Has difficulty breathing.
Is drooling excessively or having great difficulty swallowing.
Has symptoms of earache or sore throat.
Has a limp or who will not use an arm or leg.
Has significant abdominal pain.
Has painful urination or difficulty urinating.
Has any redness or swelling on his or her body.
Has a seizure (fit or convulsion).
If the illness does not appear sufficiently serious, you can help children by not over-dressing them and by encouraging then to drink small amounts of clear fluids frequently.
Also keep in mind that a child's normal body temperature varies considerably, from 97.5 to 99F. It will probably be lowest in the early morning and tend to rise as the day progresses and during active play.
"Don't rely on touch to judge a fever,". "If a child is extremely ill or dehydrated, he or she could have decreased circulation to the skin and feel cool despite having a fever. Also, when a child's temperature starts to drop, circulation to the skin may increase, allowing heat to escape, but the child may appear flushed or feel hot, despite a decreasing temperature."
Do not give children under age 16 aspirin to treat a fever, because it has been linked to Reye's Syndrome, which can be fatal. Acetaminophen is effective treatment; use one 80-mg (children's chewable) tablet for each 12 pounds of body weight.
Finally, although extremely rare, fever when accompanied by other severe symptoms can mean a life-threatening disease called bacterial meningitis. If your child has a fever greater than 101�F accompanied by severe, sudden headache and mental changes, neck or back stiffness, or rashes (small and tiny red, purple-black spots resembling bruises and usually found on the armpits, groin, ankles and areas where pressure may be applied), go to the emergency department immediately. Bacterial meningitis requires urgent medical treatment and antibiotics, because it can be fatal or cause severe handicaps, such as deafness or brain injury.

                          Childhood Diarrhea:
                           Messages for Parents
Diarrhea is the passage of loose or watery stools that may contain blood, pus, or mucus. Children with diarrhea often have additional symptoms including nausea, vomiting, stomach aches, headache, and fever.
Diarrhea can beacute- happens suddenly, and for brief periods, or chronic- an ongoing and persistent medical problem such as intestinal worms.
Diarrhea can impact the ability of the body to process and absorb necessary water, salts and nutrition and can lead to dehydration, shock and even death.
What causes acute diarrhea?
Mild, acute diarrhea can be caused by a number of conditions, including
a change in dietary habits, such as eating rich or different foods
food allergies taking medicines such as antibiotics
Serious, acute diarrhea can be caused by a variety of viruses, bacteria, and parasites including rotavirus E. coli O157:H7 Salmonella certain respiratory infections Most episodes of serious, acute diarrhea in children are caused by viruses. Diarrheal illness can be seasonal or may occur in outbreaks where many people are affected.
What is rotavirus?
Rotavirus is a virus that causes severe diarrhea, often with vomiting. Rotavirus is the most common cause of severe diarrhea in infants and young children in the United States. Worldwide, rotavirus is a major cause of childhood deaths.
Illness from rotavirus usually starts with fever, an upset stomach, and vomiting, followed by diarrhea. The diarrhea can be mild to severe and generally will last 3 to 9 days. Severe diarrhea and dehydration occur primarily among children 3 months to 35 months of age. Most cases of rotavirus diarrhea occur between November and May.Rotavirus illness is very easy to catch. Children can spread rotavirus both before and after they have signs of being sick. The virus is often transmitted from one infected child to another by contaminated hands or objects. Washing with soaps or cleansers will not kill the virus, but will help reduce the spread of rotavirus.
What is E. Coli 0157:H7?
Escherichia coli O157:H7, or E. Coli 0157:H7 is an emerging cause of foodborne illness. Infection often leads to bloody diarrhea, and occasionally to kidney failure. Most illness has been associated with eating undercooked, contaminated ground beef. Person-to-person contact in families and child care centers is also an important mode of transmission. Infection can also occur after drinking raw milk and after swimming in or drinking sewage-contaminated water.
E. coli O157:H7 infection often causes severe bloody diarrhea and abdominal cramps; sometimes the infection causes nonbloody diarrhea or no symptoms. Usually little or no fever is present, and the illness resolves in 5 to 10 days.
What is Salmonella?
The Salmonella germ is actually a group of bacteria that can cause diarrheal illness in humans. Salmonella are usually transmitted to humans by eating foods contaminated with animal feces. Contaminated foods usually look and smell normal. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables may become contaminated.
Most persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons the diarrhea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.
How do you treat diarrhea?
Dehydration is the biggest threat from diarrheal diseases in children. Illnesses that cause diarrhea or vomiting can lead to dehydration if the child loses more body fluids and salts (electrolytes) than he/she takes in. To prevent dehydration, your child may require special fluids.The best fluid to give children with diarrhea is an oral rehydration solution such as Ceralyte, Pedialyte or Oralyte. These solutions can be purchased in nearly all drug stores and grocery stores. Parents should keep 2 bottles or packages of these solutions on hand in case your child gets diarrhea. Follow the instructions on the solution according to your child�s age.
Sports drinks do not replace the fluid losses correctly and should not be used for the treatment of diarrheal illness. Children who are breastfeeding, taking formula, or eating solids should continue to follow their usual diet. The best chance to prevent dehydration, hospitalization or death from diarrheal diseases is by making sure children receive enough fluids, and by seeking medical care when diarrhea is severe or you are concerned about dehydration. It is vital to replace fluids properly. Your health care provider can help you decide what is right for your child.
When should you call a doctor if your child has diarrhea?
Contact your health care provider if diarrhea is accompanied by the following (particularly if your child is less than 6 months of age):
High fever (temperature over 101.5 F, measured orally)
Blood in stools
Prolonged vomiting that prevents keeping liquids down (which can lead to dehydration)
Signs of dehydration, including
Decrease in urination
Sunken eyes
No tears when child cries
Extreme thirst
Unusual drowsiness or fussiness
Dry, sticky mouth

Are antibiotics needed to treat diarrheal diseases?
Do not be surprised if your doctor does not prescribe an antibiotic to treat a diarrheal illness. Many diarrheal illnesses are caused by viruses and will improve in two or three days without antibiotics. In fact, antibiotics have no effect on viruses, and using an antibiotic to treat a virus infection could cause harm and will do the child no good. Antibiotics are often not needed to treat mild bacterial infections.
How are diarrheal illnesses spread?
Children and adults can become infected by coming in direct contact with the feces of an infected child and then passing the infection to the mouth (fecal-oral transmission). Often, another child or adult touches a surface that has been contaminated, touches his or her mouth and then ingests the germs. A child with a diarrheal illness may be contagious before the onset of diarrhea and for a few days after the diarrhea has ended. Germs that cause diarrhea can also be spread by contaminated food.
How do you prevent spreading diarrheal illnesses?
Careful and frequent handwashing can prevent the spread of infection to other people.Adults should wash their hands after using the toilet, helping a child use the toilet, and diapering a child and before preparing, serving, or eating food.
Children should wash their hands after using the toilet, after having their diapers changed (an adult should wash infant's or small child's hands), and before eating snacks or meals. Disinfect toys, bathrooms, and food preparation surfaces frequently, especially if a sick child has been in the home.Use diapers with waterproof outer covers that can contain liquid stool or urine, or use plastic pants
Make sure that children wear clothes over diapers.

       Hepatitis B in the Child Care Setting

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). This virus is completely different from hepatitis A. Only about 10 percent of children who become infected with HBV show any symptoms. When children do have symptoms, they may be similar to those for hepatitis A: fatigue, loss of appetite, jaundice, dark urine, light stools, nausea, vomiting, and abdominal pain. However, hepatitis B is a much more serious infection. After infection with HBV, chronic infection develops in 70% to 90% of infants, 15% to 25% of 1- to 4-year-old children, and 5% to 10% of older children and adults. Premature death from cirrhosis or liver cancer occurs in 15% to 25% of persons with chronic infection. Persons who develop chronic HBV infection may remain infectious for the rest of their lives.
HBV infection is most commonly spread: By infected mothers to newborn infants through blood exposure at birth. By sharing contaminated needles during intravenous drug abuse. Through sexual intercourse. Through exposure of cuts or mucous membranes to contaminated blood.
HBV infection can also be transmitted if infected blood or body fluids come in contact with nonintact skin of an uninfected person, such as by biting, if the skin is broken. However, this is rare.
Hepatitis B is vaccine-preventable. All infants should be vaccinated with three doses of hepatitis B vaccine during the first 18 months of life. A child not previously vaccinated should receive three doses of vaccine by the age of 11 or 12 years. Child care providers should discuss with their doctor whether it is appropriate for them to receive hepatitis B vaccine.
To reduce the spread of hepatitis B:
Require parents to submit up-to-date immunization certificates when previous certificates expire. Make sure that all children and adults use good handwashing practices. Do not allow children to share toothbrushes. Clean up blood spills immediately. Wear gloves when cleaning up blood spills unless the spill is so small it can be contained in the cloth or towel being used to clean it up. Wear gloves when changing a diaper soiled with bloody stools. Disinfect any surfaces on which blood has been spilled, using freshly prepared bleach solution. If a child care provider has open sores, cuts, or other abrasions on the hands, the provider should wear gloves when changing diapers or cleaning up blood spills. Observe children for aggressive behavior, such as biting. A child who is a chronic HBV carrier should be evaluated by a team that includes the child�s parents or guardians, the child�s physician, public health personnel, the proposed child care provider, and others to determine the most appropriate child care setting. This evaluation should consider the behavior, neurologic development, and physical condition of the child and the expected type of interaction with others in the child care setting. In each case, risks and benefits to both the infected child and to others in the child care setting should be weighed.

Bacterial Meningitis in the Child Care Setting

Meningitis is an inflammation of the membranes that cover the brain and spinal cord. The cause of this inflammation is infection with either bacteria or viruses.
Meningitis caused by a bacterial infection (sometimes called spinal meningitis) is one of the most serious types, sometimes leading to permanent brain damage or even death. Bacterial meningitis is most commonly caused by bacteria called Neisseria meningitidis (meningococcal meningitis), Streptococcus pneumoniae, or Haemophilus influenzae serotype b (H. flu meningitis). These bacteria are carried in the upper back part of the throat (called the nasopharynx) of an infected person and are spread either through the air (when the person coughs or sneezes organisms into the air) or by direct contact with secretions from the nasopharynx of the infected person. However, transmission usually occurs only after very close contact with the infected person.
Symptoms of bacterial meningitis include sudden onset of fever, headache, neck pain or stiffness, vomiting (often without abdominal complaints), and irritability. These symptoms may quickly progress to decreased consciousness (difficulty in being aroused), convulsions, and death. For this reason, if any child displays symptoms of possible meningitis, he or she should receive medical care immediately.
Meningitis caused by Haemophilus influenza serotype b (Hib) can be prevented with Hib vaccine, which is part of routine childhood immunizations. Some cases of meningococcal meningitis can also be prevented by vaccine. However, this vaccine is not used routinely, and usually only during outbreaks or in high risk children.
Children with bacterial meningitis are almost always hospitalized. Providers are often told only that the child has meningitis and may not know the exact type. If a child or adult in your child care facility is diagnosed with bacterial meningitis: Verify the type of meningitis involved. If a child in your care is diagnosed, contact the child�s physician, explain that the child attends your facility, and you need to know the type of meningitis. If H.flu is involved, review immunization status of children to identify children who have not received their Hib vaccine. Immediately contact your local health department. Many states require that child care facilities report suspected or known cases of bacterial meningitis. Your health department should also be able torecommend that you notify parents and potentially exposed persons as well as preventive antibiotics to reduce the risk of infections in exposed persons who may not be adequately vaccinated.
Closely observe all remaining children and staff for any possible early signs of illness. IMMEDIATELY refer to a physician any exposed child or adult who develops fever, headache, rashes, spots, unusual behavior, or other symptoms of concern regardless of whether they have taken preventive antibiotics.
Encourage close cooperation, support, and information sharing with staff and parents regarding measures being taken to reduce the risk of further transmission.

     Asthma in the Child Care Setting

Asthma is a chronic breathing disorder and is the most common chronic health problem among children. Children with asthma have attacks of coughing, wheezing, and shortness of breath, which may be very serious. These symptoms are caused by spasms of the air passages in the lungs. The air passages swell, become inflamed, and fill with mucus, making breathing difficult. Many asthma attacks occur when children get respiratory infections, including infections caused by common cold viruses.
Attacks can also be caused by:
exposure to cigarette smoke,
stress,
strenuous exercise,
weather conditions, including cold, windy, or rainy days,
allergies to animals, dust, pollen, or mold,
indoor air pollutants, such as paint, cleaning materials, chemicals, or perfumes, or outdoor air pollutants, such as ozone.

As with any child with a chronic condition, the child care provider and parents should discuss specific needs of the child and whether they can be sufficiently met by the provider. Some people believe that smaller-sized child care centers or family child care home environments may be more beneficial to a child with asthma because exposure to common respiratory viruses may be reduced. However, this has not been proven to be true.
Children with asthma may be prescribed medications to relax the small air passages and/or to prevent passages from becoming inflamed. These medications may need to be administered every day or only during attacks. Asthma medication is available in several forms, including liquid, powder, and pill, or it can be breathed in from an inhaler or compressor. The child care provider should be given clear instructions on how and when to administer all medications and the name and telephone number of the child's doctor.
The child care provider should be provided with and keep on file an asthma action plan for each child with asthma. An asthma action plan lists emergency information, activities or conditions likely to trigger an asthma attack, current medications being taken, medications to be administered by the child care provider, and steps to be followed if the child has an acute asthma attack. Additional support from the child's health care providers should be available to the child care provider as needed.
Most children with asthma can lead a normal life, but may often have to restrict their activity.
Some preventive measures for reducing asthma attacks include:
Avoiding allergic agents such as dust, plush carpets, feather pillows, and dog and cat dander. Installing low-pile carpets, vacuuming daily, and dusting frequently can help to reduce allergic agents. A child who is allergic to dogs or cats may need to be placed in a facility without pets.
Stopping exercise if the child begins to breathe with difficulty or starts to wheeze.
Avoiding strenuous exercise.
Avoiding cold, damp weather. A child with asthma may need to be kept inside on cold, damp days or taken inside immediately if cold air triggers an attack.
If a child with asthma has trouble breathing:
Stop the child's activity and remove whatever is causing the allergic reaction, if you know what it is.
Calm the child; give medication prescribed, if any, for an attack.
Contact the parents.
If the child does not improve very quickly, and the parents are unavailable, call the child's doctor.

Record the asthma attack in the child's file. Describe the symptoms, how the child acted during the attack, what medicine was given, and what caused the attack, if known.

Allergy, Asthma and Exercise Facts
Regular exercise is beneficial for everyone, and may be particularly helpful for individuals with asthma and other allergic diseases. Though many people with asthma avoid exercise because they fear an asthma episode, a well-planned exercise program can improve their overall physical and emotional well being and help them manage their asthma symptoms. Here are some exercise tips for allergic patients:
An exercise program should be planned in consultation with an allergist-immunologist or other physician. The doctor can advise which activities may provoke asthma or other allergic symptoms, and how to treat the symptoms.
Exercise-induced asthma symptoms such as tightness in the chest, coughing, wheezing and shortness of breath may be controlled by using an inhaled bronchodilator before exercising.
The nose should be clear when exercising. The nasal passages act as natural filters and humidifiers to keep air at proper temperatures and filter out pollutants, irritants and allergens. The proper use of medications such as antihistamines, decongestants or prescription nasal sprays can help.
With proper medical supervision, patients with asthma can train for any sport. Stop-and-go exercises such as wrestling, weight training, softball and doubles tennis are usually considered best for people with asthma. Warm, humidified air from water makes swimming an ideal sport for allergy and asthma-prone athletes.
Avoid outdoor exercise in cold, windy weather or when pollen counts are high. Exercising near fields of grass and weeds, or in areas where there are high levels of respiratory irritants, such as tobacco smoke, car exhaust or factory pollutants, also may aggravate symptoms of asthma or allergic diseases.
A person with a known severe allergy to insect stings should always carry injectable epinephrine when exercising outdoors.
When exercising indoors, stay away from open windows and doors to limit contact with outdoor allergens. Use a mat if exercising on carpeting, which can harbor allergy triggers such as dust mites and animal dander.
Limit exercise during periods when symptoms of asthma or allergic diseases are severe and may be aggravated by increased activity.

Tuberculosis (TB) in the Child Care Setting

TB is a disease caused by bacteria called Mycobacterium tuberculosis. These germs can be spread from one person to others. These germs can be spread through the air when a person with TB disease coughs, sneezes, yells, or sings. Children, although they may be infectious, usually are not as likely as adults to transmit TB to others. (TB is not spread by objects such as clothes, toys, dishes, walls, floors, and furniture.) When a person is sick from the TB germ, the person has TB disease. TB can be serious for anyone, but is especially dangerous for children younger than 5 years old and for any persons who have weak immune systems, such as those with HIV infection or AIDS.
You should know the difference between the two stages of TB: (1) TB infection is just having the TB germ in the body without being sick, and (2) active TB or TB disease is having the germ and also being sick from it, with the symptoms of active TB (see description of symptoms below).
When a child has TB infection, it means that the child was infected by an adult with active TB--often a person in the home. Most persons who have TB infection do not know it because it does not make them sick. A person with only TB infection cannot spread TB to others and does not pose an immediate danger to the public. TB infection is diagnosed only by the TB skin test. This safe, simple test is given at most local health departments. A small injection is made under the skin, usually on the forearm. In persons who are infected with the TB germ, the skin test causes a firm swelling in the skin where the test was given. After 1 or 2 days, a health care provider reads the results of the TB skin test.
A TB-infected person can take 6 to 12 months of medicine, usually isoniazid, to get rid of the TB germs and to prevent active TB (the illness with symptoms). This preventive treatment is most important for TB-infected children younger than 5 years old, persons infected with the TB germ within the past 2 years, and TB-infected persons who have a weak immune system (especially HIV infection or AIDS) because these persons are more likely to get active TB after infection.
Active TB (when infection develops into a disease with symptoms) is preventable and curable. Active TB can attack any part of the body, but it usually affects the lungs. Persons with active TB in the lungs may spread TB germs through the air by coughing, sneezing, or yelling. People who share this air have a chance of breathing in the germs and getting the infection in their lungs, too.
Persons with active TB have symptoms such as a cough that �won�t go away,� a cough that brings up blood, a fever lasting longer than 2 weeks, night sweats, feeling very tired, or losing a noticeable amount of weight. The TB skin test cannot show active TB -- active TB must be diagnosed by a physician, based on a physical exam, a chest x-ray, and laboratory tests. The treatment for active TB usually involves taking at least 3 different drugs and lasts for at least 6 months and usually cures the TB. The law states that doctors must report active TB to the local health department.
In child care settings, TB has been spread from adults to children, although the spread of TB in such settings is rare. In family home child care settings, TB infection has been passed from sick adults living in the home to children, even thought the sick adults may not have been taking care of the children directly. As noted before, a person with only TB infection cannot infect another person. Only a person with active TB can infect another person. Also, children younger than 5 years old who have active TB usually cannot infect other persons. The spread of TB from child to child in a child care setting has not been reported. Still, children under 5 years old who have active TB should not attend child care until they have been given permission. Usually, they may return to child care as soon as they are feeling well and on medication, but this should be decided by the local health department. (Well children should not be kept out of child care if they only have a positive skin test result.)
In the United States, TB is more common in some populations, for example immigrants coming from Asia, Africa, and Latin America and medically underserved minority populations. However, overall, TB infection in children younger than 5 years old is rare. Therefore, TB skin testing of all children in child care centers is not useful. However, a local health department may decide to test children who have more risk for infection. Some programs (e.g., Head Start) and some states require children to have a TB skin test before they can attend. A child who has a positive skin test result should be seen by a doctor to check for active TB and to start medicine that will prevent TB disease, if appropriate. A child should not be kept out of child care only because of a positive TB skin test result.
Persons who are beginning work as a child care provider should have a TB skin test to check for infection with TB bacteria. See the section on health history and immunization policy for child care providers for more information on tuberculosis screening for child care providers. Child care providers who comes from a community with high rates of TB may want to take preventive medicine so they will not develop active TB. Local health department TB control programs can help with these activities.

       What are febrile seizures?

Febrile seizures are convulsions brought on by a fever in infants or small children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a portion of the body, such as an arm or a leg, or on the right or the left side only. Most febrile seizures last a minute or two, although some can be as brief as a few seconds while others last for more than 15 minutes.
The majority of children with febrile seizures have rectal temperatures greater than 102 degrees F. Most febrile seizures occur during the first day of a child's fever. Children prone to febrile seizures are not considered to have epilepsy, since epilepsy is characterized by recurrent seizures that are not triggered by fever.
How common are febrile seizures?
Approximately one in every 25 children will have at least one febrile seizure, and more than one-third of these children will have additional febrile seizures before they outgrow the tendency to have them. Febrile seizures usually occur in children between the ages of 6 months and 5 years and are particularly common in toddlers. Children rarely develop their first febrile seizure before the age of 6 months or after 3 years of age. The older a child is when the first febrile seizure occurs, the less likely that child is to have more.
What makes a child prone to recurrent febrile seizures?
A few factors appear to boost a child's risk of having recurrent febrile seizures, including young age (less than 15 months) during the first seizure, frequent fevers, and having immediate family members with a history of febrile seizures. If the seizure occurs soon after a fever has begun or when the temperature is relatively low, the risk of recurrence is higher. A long initial febrile seizure does not substantially boost the risk of recurrent febrile seizures, either brief or long.
Are febrile seizures harmful?
Although they can be frightening to parents, the vast majority of febrile seizures are harmless. During a seizure, there is a small chance that the child may be injured by falling or may choke from food or saliva in the mouth. Using proper first aid for seizures can help avoid these hazards (see section entitled "What should be done for a child having a febrile seizure?").
There is no evidence that febrile seizures cause brain damage. Large studies have found that children with febrile seizures have normal school achievement and perform as well on intellectual tests as their siblings who don't have seizures. Even in the rare instances of very prolonged seizures (more than 1 hour), most children recover completely.
Between 95 and 98 percent of children who have experienced febrile seizures do not go on to develop epilepsy. However, although the absolute risk remains very small, certain children who have febrile seizures face an increased risk of developing epilepsy. These children include those who have febrile seizures that are lengthy, that affect only part of the body, or that recur within 24 hours, and children with cerebral palsy, delayed development, or other neurological abnormalities. Among children who don't have any of these risk factors, only one in 100 develops epilepsy after a febrile seizure.
What should be done for a child having a febrile seizure?
Parents should stay calm and carefully observe the child. To prevent accidental injury, the child should be placed on a protected surface such as the floor or ground. The child should not be held or restrained during a convulsion. To prevent choking, the child should be placed on his or her side or stomach. When possible, the parent should gently remove all objects in the child's mouth. The parent should never place anything in the child's mouth during a convulsion. Objects placed in the mouth can be broken and obstruct the child's airway. If the seizure lasts longer than 10 minutes, the child should be taken immediately to the nearest medical facility for further treatment. Once the seizure has ended, the child should be taken to his or her doctor to check for the source of the fever. This is especially urgent if the child shows symptoms of stiff neck, extreme lethargy, or abundant vomiting.
How are febrile seizures diagnosed and treated?
Before diagnosing febrile seizures in infants and children, doctors sometimes perform tests to be sure that seizures are not caused by something other than simply the fever itself. For example, if a doctor suspects the child has meningitis (an infection of the membranes surrounding the brain), a spinal tap may be needed to check for signs of the infection in the cerebrospinal fluid (fluid that bathes the brain and spinal cord). If there has been severe diarrhea or vomiting, dehydration could be responsible for seizures. Also, doctors often perform other tests such as examining the blood and urine to pinpoint the cause of the child's fever.
A child who has a febrile seizure usually doesn't need to be hospitalized. If the seizure is prolonged or is accompanied by a serious infection, or if the source of the infection cannot be determined, a doctor may recommend that the child be hospitalized for observation.
How are febrile seizures prevented?
If a child has a fever most parents will use fever-lowering drugs such as acetominophen or ibuprofen to make the child more comfortable, although there are no studies that prove that this will reduce the risk of a seizure. One preventive measure would be to try to reduce the number of febrile illnesses, although this is often not a practical possibility.
Prolonged daily use of oral anticonvulsants, such as phenobarbital or valproate, to prevent febrile seizures is usually not recommended because of their potential for side effects and questionable effectiveness for preventing such seizures.
Children especially prone to febrile seizures may be treated with the drug diazepam orally or rectally, whenever they have a fever. The majority of children with febrile seizures do not need to be treated with medication, but in some cases a doctor may decide that medicine given only while the child has a fever may be the best alternative. This medication may lower the risk of having another febrile seizure. It is usually well tolerated, although it occasionally can cause drowsiness, a lack of coordination, or hyperactivity. Children vary widely in their susceptibility to such side effects.
What research is being done on febrile seizures?
The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), sponsors research on febrile seizures in medical centers throughout the country. NINDS-supported scientists are exploring what environmental and genetic risk factors make children susceptible to febrile seizures. Some studies suggest that women who smoke or drink alcohol during their pregnancies are more likely to have children with febrile seizures, but more research needs to be done before this link can be clearly established. Scientists are also working to pinpoint factors that can help predict which children are likely to have recurrent or long-lasting febrile seizures.
Investigators continue to monitor the long-term impact that febrile seizures might have on intelligence, behavior, school achievement, and the development of epilepsy. For example, scientists conducting studies in animals are assessing the effects of seizures and anticonvulsant drugs on brain development.
Investigators also continue to explore which drugs can effectively treat or prevent febrile seizures and to check for side effects of these medicines.