How to manage convulsions in a 6-month-old baby with fever?

Management of Convulsions in a 6-Month-Old Baby with Fever

For a 6-month-old baby with fever-associated convulsions, perform a lumbar puncture to rule out meningitis, administer benzodiazepines for ongoing seizures, and treat the fever with acetaminophen while ensuring adequate hydration. 1

Immediate Management of Acute Convulsion

1. Ensure ABC (Airway, Breathing, Circulation):

   • Position the baby in semi-prone position to prevent aspiration
   • Monitor oxygen saturation and vital signs 1

2. Stop Ongoing Seizure:

   • If seizure is ongoing, administer:
     • IV lorazepam 0.1 mg/kg (maximum 4 mg) OR
     • Rectal diazepam if IV access not available 1
   • Check blood glucose with glucose oxidase strip if still convulsing or unrousable 2, 1

3. Fever Management:

   • Administer acetaminophen (paracetamol) for fever control
   • Ensure adequate hydration
   • Avoid physical cooling methods like cold bathing or tepid sponging as they cause discomfort 2, 1

Diagnostic Evaluation

1. Mandatory Investigation for 6-Month-Old:

   • Lumbar puncture is strongly indicated in infants under 12 months with febrile convulsions 2, 1
   • Blood glucose measurement if still seizing or unresponsive 2

2. Additional Investigations (if clinically indicated):

   • CBC, electrolytes, and blood culture to identify source of fever 1
   • Neuroimaging (CT or MRI) only if persistent altered mental status, focal neurological deficits, or concern for increased intracranial pressure 1

3. Important Considerations:

   • A comatose child must be examined by an experienced doctor before lumbar puncture due to risk of coning 2
   • EEG is not routinely recommended after a first febrile seizure 2, 1

Hospital Admission Criteria

Admit the 6-month-old baby if:

• First febrile seizure at this young age
• Incomplete recovery after 1 hour
• Signs of serious infection or dehydration
• Parental anxiety that cannot be adequately addressed 1

Follow-up and Parent Education

1. Explain to Parents:

   • Febrile convulsions are relatively common, affecting 3-4% of children 3
   • The risk of recurrence is approximately 30% 2, 1
   • Risk factors for recurrence include young age at first seizure and family history 2

2. Provide Instructions on:

   • Fever management with acetaminophen
   • Ensuring adequate fluid intake
   • Consider teaching parents to administer rectal diazepam for prolonged seizures 2, 1

3. Arrange Follow-up:

   • Follow-up with primary care physician
   • Consider neurology referral if seizure was complex (focal, prolonged, or multiple) 1

Important Caveats

• Febrile convulsions should be distinguished from seizures due to intracranial infection (meningitis, encephalitis) or acute electrolyte imbalance 4, 3
• Children who have a prolonged seizure or who have not completely recovered within one hour should be suspected of having a serious condition and investigated accordingly 2
• Long-term anticonvulsant therapy is not recommended as the potential toxicities outweigh the risks associated with febrile seizures 1
• The prognosis for most children with febrile convulsions is excellent, with only about 2.5% risk of subsequent epilepsy after a simple febrile seizure 2, 4