Category Archives: neuro problem

disease related to central nervous system of children, eg meningitis, seizures etc

Febrile Seizure in Children; What to do?

fever

What is Febrile Seizure?

Febrile means feverish; any seizure or convulsion which is accompanied by fever is known as febrile seizure.  The look of child during seizure seems life threatening (Child’s whole body is shivering, shaking, twitching, eyes may roll up, there could be frothing from mouth and child may become unconscious) and it can be very frightening for parents.

They are scary to witness but remember that they are fairly common.  But they are usually not serious and there have NO long term bad effects on brain.

Simple Febrile Seizure typically occurs in

  • Age: 6 months to 5 years
  • Usually happens on the first day of febrile illness
  • Lasts for few minutes only
  • It is generalized (i.e. not localized to one body part)
  • Usually occurs once in 24 hours
  • No previous neurological illnesses in child

  Febrile seizure 2

Salient Features:

  • Currently there is no evidence that simple febrile seizures cause structural damage to the brain
  • With the exception of a high rate of recurrence, no long-term adverse effects of simple febrile seizures have been identified.
  • Administering prophylactic acetaminophen/Paracetamol (any other fever drug) during febrile episodes was ineffective in preventing or reducing fever and in preventing febrile-seizure recurrence
  • Long-term therapy with antiepileptic drugs is not recommended
  • Febrile seizures are not considered epilepsy, and kids who’ve had a febrile seizure; only have a slightly increased risk for developing epilepsy compared to the general population.

Management:

Just the site of your baby during seizure can be terrifying and very distressing for parents but Do not Panic (The episode might look life threatening but febrile seizures are very benign and child’s brain development is normal)

Febrile_Seizures-11

Follow  these steps:

  • Make sure your child is in a safe place.
  • Put your child sideways by turning the body to one side; to prevent choking
  • Watch for danger signs like breathing difficulty, child turns blue.
  • Wait for Seizure to get over and then shift the child to nearest hospital/medical care facilities for proper evaluation of your child’s condition and to rule out serious illnesses like Meningitis.

Things one should NOT DO:

  • Do not shake the child, or try to hold or restrain your child.
  • Do not put anything in your child’s mouth.
  • Do not try to give any medicine while child is in active seizure not even fever-reducing medicine.
  • Do not try to put your child into cool or lukewarm water to cool off.

When the seizure is over, meet your child doctor to look for causes of Fever. The doctor will examine your child and ask you to describe the seizure. In most cases, no additional treatment is necessary. The doctor may recommend the standard treatment for fevers, which is paracetamol or ibuprofen.

Conditions which need urgent Hospitalization are

  • If the child is under 1 year old, looks very ill, or has other symptoms such as diarrhea or vomiting; child will go through few tests to rule out other illnesses like Meningitis and determine the cause of fever.
  • The seizure lasts more than several minutes
  • If the child is having breathing difficulty or child turns blue
  • If the child looks ill, lethargic and is not responding normally
  • Persistent vomiting is there

febrile seizure

Medications:

Midazolam nasal spray, Tablet Frisium, and various other medications might be prescribed by your child’s doctor as per need of your child and hospital protocol.

Investigations:

Neuroimaging and EEG need to be done during first episode just to rule out other illnesses with seizure. Investigations to find the cause of fever may also be done which may include few blood test and urine test.

EEG seizure

Recurrence of Febrile Seizures is high in following cases:

  • Younger children (less than 18 months)
  • Shorter duration of fever before onset of seizure increases the risk of recurrence
  • Family history of febrile seizure (in sibling or any other family member)
  • Lower the peak of Fever at onset of seizure ,higher the chances of recurrence

Few children might develop seizure without fever later. These children have

  • Complex febrile Seizure
  • Family history of epilepsy
  • Neurological illness or developmental delay (eg. Cerebral palsy, Hydrocephalus etc)
Simple Febrile Seizure Complex Febrile Seizure
Age: 6months to 5 years They can occur before and after that
Lasts only few minute Last longer even up to 15 minutes
Generalised (Whole body involved) Localised / Focal (May involve only one body part)
No previous neurological issues May have previous neurological illnesses like Cerebral Palsy
Once in 24 hour period Can occur more than once in 24 hours

 

To Summaries:

Simple febrile seizure is a benign and common event in children between the ages of 6 and 60 months. Nearly all children have an excellent prognosis. There is evidence that both continuous antiepileptic therapy with phenobarbital, primidone, or valproic acid and intermittent therapy with oral diazepam are effective in reducing the risk of recurrence, the potential toxicities associated with antiepileptic drugs outweigh the relatively minor risks associated with simple febrile seizures. As such, long-term therapy is not recommended. In situations in which parental anxiety associated with febrile seizures is severe, intermittent oral diazepam at the onset of febrile illness may be effective in preventing recurrence. Although antipyretics may improve the comfort of the child, they will not prevent febrile seizures

For any queries feel free to contact Maya Clinic.

Regards

Dr Rahul Varma

Bed wetting: how to deal with this very common illness

Bed wetting: how to deal with this very common illness

bedwetting

“Bedwetting is a topic people often shy away from. Parents may be embarrassed to broach the subject with their child specialist/pediatrician, and doctors typically assume that if a child is wetting the bed, the parents will inquire about it. Parents need to be proactive and talk with their child’s pediatrician.”

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Bedwetting (sometimes called nocturnal enuresis) is a common condition that affects many children and young people. Although most children grow out of it, this may take many years and some may need help to become dry at night. It can be very distressing and have a considerable impact on the child or young person. It can also be very stressful for their family.

bed-wetting Bedwetting-Boy-D1

Although bedwetting is rarely caused by a serious medical disorder and often resolves itself, it’s a condition that can create anxiety, embarrassment, and shame. These feelings are heightened when the child is invited to a sleepover —by relatives, friends and during family marriage.

The combination of several factors is the usual culprit that leads to bedwetting: an increased production of urine during the night, a small bladder capacity, poor arousal from sleep, and constipation.

kidneybrainboy

Parents should keep two issues in mind.

  • First, bedwetting is common, and children should not be punished for it.
  • Second, parents should always remember that bedwetting is a medical problem — it happens because a child’s brain and bladder are not communicating with each other at night.

 

What Parents Need to Know

Most frequently asked questions about bedwetting.

  1. Does bedwetting run in families?
    Most children who wet the bed have at least one parent or close relative who had the same problem as a child. Approximately 45 percent of children wet the bed if one parent wet the bed as a child, and 75 percent wet the bed if both parents were bedwetters.
  2. Is bedwetting more common in boys or girls?
    Prior to age 13, boys wet the bed twice as often as girls. By the time adolescence rolls around, these numbers equal out. Interestingly, girls are more likely than boys to have other bladder symptoms, such as urgency, frequency, or daytime wetting.
  3. Does bedwetting go away on its own?
    Every year, 15 percent of children older than 5 who wet the bed become dry with no intervention. Although children usually follow the same pattern as their family members, this is not always the case. Because there is no way to predict when a child will overcome his wetting, I recommend that children start a bedwetting program if they’re motivated to become dry.
  4. How can I tell if my child is motivated to work on becoming dry at night?
    There are four signs you can look for to see if your child is ready to work on becoming dry:

    1. He starts to notice that he’s wet in the morning and doesn’t like it.
    2. He tells you he doesn’t want to wear Pull-Ups/ diapers anymore.
    3. He tells you he wants to be dry at night.
    4. He doesn’t want to go on sleepovers because he’s wet at night.
  5. Do you recommend restricting fluids in the evening to keep children dry?
    Some people think restricting fluids after dinner helps children stay dry. Although this helps some children, it doesn’t work for most — if a child limits fluids, he may wet the bed with four ounces of urine instead of six, but he’s usually still wet. My approach to restricting fluids is practical. If a child tells me that limiting fluids helps him stay dry, I give it my “OK.” Otherwise, I generally don’t recommend this approach. Stopping tea, coffee, milk at night do help.
  6. What is the best way to treat bedwetting?
    Behavioral Therapy is best approach with help of bedwetting alarm; it yields the best results. Bedwetting alarms are now available in India. This device teaches the child’s brain to pay attention to his bladder while sleeping. Bedwetting alarms have two basic parts. (1) a wetness sensor that detects urine and (2) an alarm unit that produces a loud sound when a child wets the bed.
  7. How does the bedwetting alarm work?

alarm   images

The alarm’s sensor has the ability to detect small amounts of moisture. When a child wets the bed, the urine in his underpants turns on the alarm. When the alarm goes off it awakens the child so he can go to the bathroom and finish urinating in the toilet. After weeks of hearing the alarm, the child’s brain learns to pay attention to the full bladder signals and he wakes up before wetting the bed.

9. Are drugs an effective way to treat bedwetting?

The medication that is prescribed most frequently is called desmopressin (brand name: DDAVP). Desmopressin is a manufactured form of the hormone the brain produces to decrease urine production at night. The effects of desmopressin only last for a short period of time, and children usually relapse when medication is stopped. For this reason, doctors generally recommend this for sleepovers, vacations, or special occasions.

Words of Encouragement for Children

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Following are the strategies to help ease your child’s anxiety.

  • Do not punish or shame children for being wet at night.
  • Remind children that bedwetting is no one’s fault.
  • Let children know that lots of kids have the same problem.
  • Let children know if anyone in the family wet the bed growing up.
  • Maintain a low-key attitude after wetting episodes.
  • Praise children for success in any of the following areas: waking up at night to urinate, having smaller wet spots or having a dry night.
  • Encourage children to go on sleepovers.

Treatment:

  • Behavior therapy is main stay of treatment. Positive attitude and patience on part of parents is the biggest virtue on basis of which successful treatment depends.
  • Have a proper schedule; give dinner 2 hours prior to sleep and wake child once after going to sleep for toilet. Eg. If child sleeps around 11 pm, then dinner should be taken by 9 pm. Child should be asked to go to toilet before going to sleep and put an alarm around 1 am – 2 am. Waking child only once during night gives best result as repeatedly waking child during night have a bad impact on child’s behavior and may make child stubborn.
  • More than 70 to 80% children recover with this lifestyle only; but parents and every member of family need to support the child and encourage him. He should not be taunted or scolded. Otherwise all the hard work put by parents will go waste if you beat your child or scold your child in between sometimes.
  •  Do not discuss about bedwetting with others (relatives and friends) in front of child. Child feel embarrassed and it has devastating effect on child’s psychology.
  • Remember he/she is your child and not doing it deliberately. If you guys do not control your anger and frustration, your child will never come out of it. And your  personal or professional anger or frustration should not disturb your relationship with your child.
  • Drinks containing caffeine (such as cola, tea and coffee) should be avoided.
  • Milk should be given during day only and not during evening or night.
  • The child or young person should be given advice on the importance of using the toilet regularly during the day and you should encourage use of the toilet at regular intervals (around four to seven times a day, including just before bed). This should continue alongside any other treatment for bedwetting.
  • Reward System: Rewards should be given for agreed behavior  rather than dry nights, for example, they may be given for drinking the correct amount during the day, using the toilet before sleep, helping to change wet sheets, and, if appropriate, taking tablets or using an alarm correctly. These should be agreed with the child or young person beforehand. Systems that punish or take away rewards should not be used.
  • Punishment is absolutely NO. All your gains will vanish if you keep punishing child even once in a while. If punishment continues, your child will become more stubborn and as they grow old more behavior issues creep up like aggressive behavior, anti social behavior, drugs etc.
  • Desmopressin treatment:  A drug called desmopressin should be offered  to treat bedwetting under supervison of child specialist,
    • If fast or short-term improvement is the priority.
    • Other drugs like anticholenergic along with desmopressin and Imipramine can also be given but only after consulting someone who is expert in this field as these drugs need to be used with caution.

 

Feel free to contact Maya clinic for further queries regarding this topic.

At Maya Clinic, we have Child Development and Behavior Specialist; Dr. Smitha Sairam. She can be consulted with prior appointment only.

Stay Healthy

Regards

Dr. Rahul Varma