From the Guidelines
Follow-up care for an 18-month-old male who presented with fever and seizure should include close monitoring of temperature every 4-6 hours while febrile, using acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) to control fever, as recommended by the American Academy of Pediatrics 1. The patient's parents should ensure adequate hydration by offering fluids frequently. A follow-up appointment with the pediatrician should be scheduled within 48-72 hours to reassess the child's condition. If seizures recur, emergency medical attention should be sought immediately. Parents should keep a seizure diary noting duration, characteristics, and associated symptoms. Neurological follow-up may be recommended within 1-2 weeks, possibly including an EEG to evaluate brain electrical activity, as the risk of developing epilepsy is slightly higher in children with simple febrile seizures, although still relatively low 1. It is essential to note that anticonvulsant therapy is not recommended for children with simple febrile seizures due to the potential toxicities associated with these agents outweighing the relatively minor risks associated with simple febrile seizures 1. Febrile seizures often occur in children between 6 months and 5 years when body temperature rises rapidly, affecting approximately 2-5% of children, and while most febrile seizures are benign and self-limiting, proper follow-up care is essential to monitor the child's development and prevent complications 1. Key aspects of care include:
- Monitoring temperature and controlling fever with acetaminophen or ibuprofen
- Ensuring adequate hydration
- Scheduling a follow-up appointment with the pediatrician
- Seeking emergency medical attention if seizures recur
- Keeping a seizure diary
- Considering neurological follow-up and EEG as needed.
From the Research
Follow-up Care Recommendations
For an 18-month-old male patient who presented with fever and seizure, the following are some key points to consider for follow-up care:
- The patient's condition should be monitored closely for any signs of further seizures or neurological deficits 2.
- Antipyretic agents such as acetaminophen or ibuprofen may be used to manage fever, but they have been shown to be ineffective in preventing recurrences of febrile seizures 3, 4, 5, 6.
- Intermittent oral diazepam or rectal diazepam may be considered for preventing recurrences of febrile seizures, but their use should be weighed against the potential for adverse effects 4, 5.
- Parents and families should be educated on the benign nature of recurrent febrile seizures, as well as how to manage them and when to seek medical attention 4, 5.
Potential Treatments
Some potential treatments for febrile seizures include:
- Intermittent oral diazepam: has been shown to reduce the recurrence of febrile seizures in some studies 4, 5.
- Rectal diazepam: may be used to prevent recurrences of febrile seizures, especially in children who have a history of febrile seizures 4, 5.
- Antipyretic agents: such as acetaminophen or ibuprofen, may be used to manage fever, but are not effective in preventing recurrences of febrile seizures 3, 4, 5, 6.
Important Considerations
It is essential to note that:
- Febrile seizures are generally benign and do not require long-term antiepileptic medication 4, 5.
- The use of antiepileptic drugs should be carefully considered, as they can have adverse effects and may not be effective in preventing recurrences of febrile seizures 4, 5.
- Parents and families should be supported with adequate contact details of medical services and information on recurrence, first aid management, and the benign nature of the phenomenon 4, 5.