Convulsions

 

Febrile Convulsions

 

A child may suddenly develop a fit or convulsions for several reasons. The commonest cause of fits in children between the age of 3 months and 6 years is a sudden rise of temperature which is most often caused by a viral infection. The child suddenly becomes unconscious, his body goes rigid and son thereafter he starts vigorous jerking of his upper and lower limbs. The jerking and unconsciousness may continue for several minutes. He then recovers slowly, looks confused and drowsy and may go off to sleep. The fit caused by the sudden rise of temperature in this age-group is called ‘febrile convulsion’ and is generally benign in nature. It may run in some families and recur during episodes of fever.

 

The mother should remain calm during her child’s febrile convulsion. Under no circumstances, should she pour water or try to force any liquid into the child’s mouth during the fit or while he is drowsy afterwards. No effort should be made to forcibly open his clenched teeth. He may be held lightly to avoid injury to his limbs. After the jerking stops, the child should be turned on his side so that he does not inhale his saliva or get choked on his tongue. Tepid sponging may be commenced to bring down the temperature and paracetamol given when he is fully conscious. In a child who has a past history of fits associated with fever, the mother should take prompt measures to prevent the temperature from rising high by the early use of paracetamol and by sponging the body with tepid water. She should also carefully follow the doctor’s instructions in this matter.

 

Epilepsy and Fits Due to Other Causes

 

Recurrent convulsions in children may also be due to epilepsy. The condition requires proper investigation and regular administration of drugs under the supervision of a doctor. The immediate management of an epileptic fit in a child is done on the same general lines as described above for febrile fits. The problem of epilepsy has been discussed at length in the section on Common Diseases in children.

 

If the fits persist for longer than 15 minutes, other more serious causes of fits like infection of the brain (encephalitis) and its membranous covering (meningitis), and others need to be identified. The child should be quickly taken to a hospital for proper management.

 

Unconsciousness

 

A child may suddenly become unconscious following an injury to his head, due to fits associated with fever, epileptic fits, an overdose of insulin or excessive rise of blood sugar in a diabetic child or some other condition effecting the functioning of the child’s brain.

 

What to Do

 

●      Do not let the child lie on his back. Turn him half - way over onto his front. Let his head and face also rest sideways so that the nose is clear from the ground.

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●      Do not give him anything to eat or drink. Stay close to him and watch him carefully all the time.

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●      Gently shake him by the shoulders or pinch his ear lobes. If he responds, watch him further. If he does not, check if he is breathing.

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●      If the child is not breathing, begin mouth-to-mouth breathing immediately.

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●      You may further need to simultaneously do chest compression, if you cannot feel his pulse. Continue these measures until the child begins to breathe on his own or medical help becomes available.

 

 

Resuscitation

 

In order to survive all of us need a constant supply of oxygen. The brain of a child may get permanently damaged or he may die if he does not get oxygen supply for as short a time as three minutes. This may occur due to the child being unconscious for some reason and not breathing or if there is complete obstruction to his breathing passages.

 

In order to revive the child three essential things are needed:

 

●      The throat and lower passages through which air travels into the lungs must remain open. If there is any obstruction in them (for example, due to an inhaled foreign body) steps have to be taken to cleat the obstruction.

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●      The child is made to breathe or we have to breathe for him and thus supply oxygen to his blood and brain. This is done by giving ‘artificial ventilation’. One simple, readily available way is to do mouth-to-mouth breathing. We blow our own expelled air into the child’s lungs.

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If the child’s heart stops, we physically ‘compress the chest’ to squeeze blood through the heart and around the body in order supply life sustaining oxygen to the child’s brain and other vital organs. Many times we have to do both artificial ventilation and chest compression, (heart massage) after ensuring that air passages are open.