Clinical Reference Systems: Pediatric Advisor 10.0

Description

During a convulsion (seizure), a child becomes unconscious and falls, the eyes roll backward, the body stiffens, and the arms and legs jerk. Most seizures last less than 5 minutes. Convulsions without fever occur in 0.4% of children. If they become recurrent, the child is said to have epilepsy. While the causes are many, the usual cause is a small scar in the brain tissue that triggers seizures. Recurrent seizures can usually be controlled with special medicines (anticonvulsants).

Reasons for Admission to the Hospital

Main complication: ________________________________________.

__ Needs IV fluids.

__ Needs IV medications.

__ Needs oxygen.

__ Other reasons: _________________________________________.

Requirements for Discharge

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

First Aid for Future Seizures

1. Leave your child on the floor or ground.

   During a seizure your child should be left on the floor or ground. Move him only if he is in a dangerous place.

2. Protect your child's airway.

   If your child has anything in the mouth, clear it with a finger to prevent choking. Place your child on the side or abdomen (face down) to help drain secretions. If the child vomits, help clear the mouth. Use a suction bulb if available. If your child's breathing becomes noisy, pull the jaw and chin forward by placing two fingers behind the corner of the jaw on each side (this will automatically bring the tongue forward).

3. Common mistakes in first aid for convulsions.

   During the seizure, don't try to restrain your child or stop the seizure movements. Once started, the seizure will run its course no matter what you do. Don't try to resuscitate your child just because breathing stops momentarily for 5 to 10 seconds. Instead, try to clear the airway. Don't try to force anything into your child's mouth. This is unnecessary and can cut the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger. Don't try to hold the tongue. Children may rarely bite the tongue during a convulsion, but they can't swallow the tongue.

Discharge Instructions for Home Care

1. Seizure medicine

   Your child's medicine is ______________________. Your child's dose is ___________________ given __________times a day. Be careful not to miss doses.

2. Treatment for break through seizures

   After the seizure is over, let your child sleep if he wishes. The brain is temporarily exhausted, and there is no point in trying to keep your child awake. There is no need to bring your child to an emergency room for every seizure if the seizures are infrequent and last less than 5 minutes.

   When you discuss your child's treatment with your physician, ask if you should give your child an extra dose of anticonvulsant medicine right after a seizure to prevent another seizure. If your child has recently missed a dose of anticonvulsant medicine, twice the usual dose may be in order.

3. Precautions

   While most sports are safe, be certain your child avoids activities that would be unsafe if he suddenly had a seizure. These include activities at heights (for example, climbing a tree or rope), cycling on a highway, or swimming alone. Wind surfing, scuba diving, and hang gliding must also be avoided. Have him take showers instead of baths and only when someone else is in the house.

Medicines

• For pain or fever over 102ƒF (39ƒC) give _______________________
• ______________________________________________________
• ______________________________________________________

Additional Instructions

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

Follow-Up Appointment after Discharge

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call your doctor if you have any concerns.

Call Your Child's Physician Immediately If (for children with diagnosed epilepsy):

• The seizure lasts more than 5 minutes.

  (Note: If the seizure lasts more than 10 minutes, you probably should call an ambulance. In general, a seizure won't hurt the brain unless it continues for at least 30 minutes.)

• Another seizure occurs.

Suggested Reading

Epilepsy: Book List