Tag Archives: child specialist vasundhara ghaziabad

My Child had a fall; what should I do?

Protect Your loved ones: Child injuries can be prevented



Young children are always on the go, running around, jumping, climbing, and exploring things. That is why they are bound to fall a few times. But situation can be a bit panicking sometime for parents. Most of these falls will cause minor injuries only like bruising cut etc, but some can be serious and we should know what to do for first aid and when to contact child doctor and emergency services.

What need to be done?

If any of the below things happen, need to call ambulance and plan to shift child to nearby hospital

  • Child unconscious
  • Having difficulty in breathing
  • Having Seizure
  • Suspected serious injury to head, neck, back
  • If not breathing at all start CPR

injury in child

If by your assessment you feel child is fine i.e. actively moving, breathing, conscious and no major bleed; then

  • Make your child comfortable (either taking child in lap or putting child to bed with you close by)
  • Cold sponging can be done on any obvious bump or minor bruises
  • Can give Ibuprofen or paracetamol (in age appropriate dose as told by your pediatrician in past)
  • Do not leave child unattended for next few hours
  • Let the baby rest, as after initial period child might sleep for next few hours.
  • Watch closely for any danger sign (explained in next section)

Danger signs to look for

  • Repeated vomiting
  • Bleeding from Ear, Nose or Throat
  • Child is sleepy most of the time or loses consciousness at any time
  • Very irritable all the time and difficult to comfort the baby even after giving painkiller
  • Child is complaining of severe pain in any part of body especially head, neck
  • Not able to see properly or difficulty in focusing on objects
  • Not able to walk properly
  • Any other thing or symptom which you feel is not right (it is always better to consult child doctor in case of doubt)


Prevention is better

  • Never leave children unattended while they are playing (whether indoor or outdoor)
  • Childproof all the gates, doors, side railing on stairs, so as to avoid child accidentally opening them and putting themselves in danger
  • Child-Proofing
  • Always put straps/ seat belts for kids while they are using high chair, car seats, strollers etc
  • Wear all the protective gears in outdoor activities like skating, biking etc
  • Do not keep sharp objects in open and try to avoid furniture and decorative stuffs with sharp edges.
  • Supervision is must whenever your child is in balcony, roof or any place that is high up
  • Fall from bed is very common at night. So try to have cot with railing which is properly fixed
  • If you are sharing your bed with kids (common practice in India), make sure baby in sleeping in between both the parents. Best is try to have some sort of protection on all the four sides of child, as your baby can turn 360degree during sleep and fall from any side. (You can have low floor beds).


Discuss with your child specialist during routine visit what all you can do to prevent injuries in children.



Dr Rahul Varma

“Safe kids, Healthy kids”

FAQ regarding Plaster cast care in Kids.

 fiberglass cast kids

Plaster Cast Care

Children sometimes need cast for proper healing of injured bone. Parents as well as kids will have lots of queries regarding cast. In this blog we will try to answer few common ones.

  1. What is a plaster cast? A cast is something which prevents bone from moving and helps in early healing. It is basically a big bandage with multiple layers (soft cotton inside and hard outer layer) to prevent bone from moving.
  2. Types of Casts available? Mainly 2 types:
    • Plaster of Paris (POP): white powder bandage that forms a thick paste and hardens quickly when mixed with water. Once hard and dried they need to be prevented from getting wet
    • Fiberglass or Synthetic: they are plastic material which is mold able, comes in various bright colors, water resistant and are lighter in weight but heavier on your pocket (expensive).
      plaster cast Vs Fiberglass
  3. How cast is applied? Initially layer of soft cotton is wrapped around injured area after cleaning. Next, either fiberglass or POP cast is applied over soft inner layer.
    plaster Cast kids
  4. Can POP cast get wet? NO, a big No. Wet cast will not hold in place and may even irritate the underlying skin. Cover in plastic bag if you need to go near water. Give sponge bath instead of shower.
  5. Can Fiberglass or synthetic cast get wet? They are water proof from outside but inside soft padding can get wet.
  6. Can my friends sign or draw on my POP cast? Yes, surely it can make the whole experience little less painful for the kids. You can even put stickers and draw some pictures and messages. It will be difficult to write on fiberglass cast.
    writing on cast
  7. What to do if my child has itching? Try to blow some cool air using hair dryer (never use warm or hot air). Do not put oil or baby powder or scratch; as it can irritate skin, can even lead to infection.
  8. What to do if skin or finger’s get blue or pale or tingling sensation? It could be very tight plaster so consult your doctor immediately. There could be redness at the edges of fiberglass cast if child picks on the padding underneath.
    blueness of finger
  9. If the cast cracks, what can be done? Consult your doctor for that. It can occur due to cast being hit or crushed or injured area beneath has swelled.
  10. Will cast be painful? For 1st few days it can be painful (but not very severe), doctor might prescribe pain killer medications like ibuprofen. After a while it is fine.
  11. Is it necessary to put all broken bones under cast? some fractures like ribs, collarbone do not need casts , they heal on its own. Some may need special strap like “figure of eight strap for collar bone”. Splint or buddy tape for fractured finger.
  12. How will the cast be removed? Using electric saw. It might look scary and child might feel vibratory movement. It is very quick and painless procedure.
    Digital Camera Exif JPEG

13. Once cast is removed, what next? It might look very pale, dry and small. You may feel very weak while moving the body part. But do not worry everything will be fine soon. You will need good physiotherapy for early recovery. Exercise under warm water will also help.


When to call doctor urgently:

  • High grade fever
  • Severe Pain
  • Tingling or numbness
  • Swelling or redness increases near plaster cast
  • Cold peripheries
  • Foul smelling discharge from cast
    redness and pain

Key Points or Summary:

  • Keep cast clean and dry
  • Can put extra padding near rough edges of cast to protect against scratches.
  • In case of Itching over skin, hair dryer can be used in cool setting. But never blow hot air into cast.
  • Do not insert anything to scratch inside the cast.
  • Encourage child to move his or her fingers or toes to promote circulation
  • Do not bear weight on the cast


Feel free to call your doctor or MAYA CLINIC for any queries.


Dr Rahul Varma

“ Healthy Kids, Happy Family”

How to manage Cough in children ?


Most common symptom and in all probabilities every child has had it once.  Important fact which I would like to share is that COUGH is a Protective reflex. It protects the spread of infection to airways in lung. But on certain occasions it needs a doctor’s visit; especially if the child is having breathing difficulty and not able to sleep at all at night.

Different types of Cough:


Cough with barking sound:

Swelling in upper airway leads to barking cough i.e. swelling of Voice box (Larynx) or Windpipe (trachea) or whole of upper part in LTB (Croup). Croup is due to viral infection in most cases. It is sudden in onset and severe in younger kids with narrow airway. It has harsh, noisy character which occurs when child inhales.

Cough with whistling (or musical sound):

When lower airway is involved it leads to musical or whistling sound. It can be sometimes audible from a distance too. Common causes are viral infections like Bronchiolitis in young children, WALRI & Asthma. Foreign body is also important cause in kids.


Cough with Fever:

Cough associated with mild fever & running nose is mostly due to common cold. But if cough is associated with high grade fever and no running nose and breathing difficulty than Pneumonia needs to be ruled out. You should visit your child specialist soon.


Cough with vomiting:

Post tussive vomiting is very common in young children and should not be a cause a worry. As babies are not able to throw up mucus and secretions from lungs naturally by taking deep breath voluntarily, so vomiting with cough might relieve the child for some times . It occurs as cough can sometimes trigger gag reflex.

Persistent Cough:

Viral infections can last for 2 weeks. Children with asthma, allergies or chronic infections or repeated viral infections can cause persistent cough but if cough persists for more than 3 weeks than doctor visit is needed.

Prevent triggers: Cold Air, perfumes, Smoke, ice creams etc can start or prolong the cough in children.

When is the right time to visit Child Specialist?

If your child is having any of the below features, you should contact your pediatrician

  • Fast breathing
  • Deep and effortful breathing
  • Bluish color on lips, face
  • High grade fever and no running nose
  • Young child less than 3 months old especially with fever
  • Special sound with cough. Eg Whopping cough, Stridor (noisy), musical sounds/ wheezing etc
  • Blood with cough
  • Child is very weak, irritable and cranky
  • Poor oral intake, decrease urine output and looks dehydrated.


Expected treatment from Doctor?

Listening to the sound of cough can help doctor, besides History and clinical examinations.

Doctor should try to find the cause of cough and treat that. If it is viral infection, it will have its own course and will settle down with time only (usually around 2 weeks in children). No need of any cough syrup (medicine), unless the cough is disturbing sleep or child is coughing continuously for few minutes at a stretch and his life is disturbed significantly.

If cough medications are to be used than it is better to avoid combination drugs.


Home remedies:

  • Honey at bed time can have soothing effect and prevent cough.
  • Warm milk with Haldi
  • Warm saline gargles
  • Steam inhalation can be given in certain cases. But in small kids , need to be very careful that they do not get burn injury with hot water. Best way is to generate steam via hot water in closed room or bathroom. And sit with your child in that room and let the child breath normally.
  • Cool-mist humidifier in your child’s bedroom might help with sleep.
  • Keep child well hydrate
  • Avoid over the counter medications and give them only on prescription of a child specialist.


Feel free to contact MAYA CLINIC for any queries.


Dr Rahul Varma

“Healthy Kids, Happy Family”

Rashes over face in children: It could be Atopic Dermatitis


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ECZEMA: Very common skin problem in children.

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Atopic dermatits is a most common form of Eczema.

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It usually begins in Infants (less than 1 year old child). It improves as the child grows older and resolves by the time child starts going to school or reaches puberty. Some children may develop chronic disease.

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Sensitive skin which is more easily irritated by sweating, heat , rough clothing and some detergents, soaps etc. Some may have allergies to food, pets, dust mites.

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Red, dry, itchy patches on skin. Itching may be severe and constant; with frequent scratching, skin may develop blisters, oozing, crusting.

Affects mainly face, scalp arms, legs.

images (11)


No Cure , but can be controlled with good skin care

  • Bathing: gentle soap, limit time.
  • Topical (Skin) Medicines: topical steroids needed in severe cases or during flare up
  • Moisturizers: apply moisturizer 30 minutes after you apply any topical medicines. This allows it to seal the medicine. Eg vaseline or any petroleum jelly.
  • Anti histamines: anti allergic medicines to decrease itching. It can make child sleepy.
  • Environmental Triggers: Avoid food, pets, dust mites that can trigger this conditions.
  • Skin Infections: chances of secondary infections are there so your child might need topical antibiotics as well.

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When to call doctor:

Mild to moderate cases can be managed by your child specialist but in severe cases or if no improvement than need to consult dermatologist or skin Specialist.

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Dr. Rahul Varma

Children with Constipation : what can be done


  • Pain or crying during the passage of a stool (bowel movement or BM) OR
  • Unable to pass a stool after straining or pushing longer than 10 minutes OR
  • 3 or more days without a stool (Exception: Breastfed and over 1 month old)

Imitators of Constipation: Normal Variations

  • If breastfed and over 1 month old: Infrequent stools every 4-7 days that are soft, large and pain-free can be normal.
  • Before 1 month old, infrequent stools usually means an inadequate intake of breastmilk.
  • Grunting or straining while pushing out a stool is normal in young infants. (Reason: difficult to pass stool lying on back with no help from gravity) Infants commonly become red in the face during straining.
  • Brief straining or pushing for less than 10 minutes can occur occasionally at any age.
  • Large stools – Size relates to amount of food consumed and stool frequency. Large eaters have larger stools.
  • Hard or dry stools are also normal if passed easily without excessive straining. Often relates to poor fiber intake. Some children even have small, dry rabbit-pellet-like stools.


  • High milk or cheese diet
  • Low fiber diet
  • Postponing stools
  • Slow intestinal transit time (genetic differences)

Home Care Advice for Constipation

  1. Normal Stools:
  • Once children are on a regular diet (age 1 year), the normal range for stools is 3 per day to 1 every 2 days.
  • The every 4 and 5 day kids all have pain with passage and prolonged straining.
  • The every 3 day kids usually drift into longer intervals and then develop symptoms.
  • Passing a stool should be fun, or at least free of discomfort.
  • Any child with discomfort during stool passage or prolonged straining at least needs treatment with dietary changes.

2. Diet for Infants Under 1 Year:

  • For infants over 1 month old only on breast milk or formula, add fruit juices 1 ounce (30 ml) per month of age per day. Pear or apple juice are OK at any age. (Reason: treating a symptom)
  • For infants over 4 months old, also add baby foods with high fiber content twice a day (peas, beans, apricots, prunes, peaches, pears, plums).
  • If on finger foods, add cereal and small pieces of fresh fruit.

3. Diet for Children Over 1 Year Old:

  • Increase fruit juice (apple, pear, cherry, grape, prune) (note: citrus fruit juices are not helpful).
  • Add fruits and vegetables high in fiber content (peas, beans, broccoli, bananas, apricots, peaches, pears, figs, prunes, dates) 3 or more times per day.
  • Increase whole grain foods (bran flakes, bran muffins, graham crackers, oatmeal, brown rice, and whole wheat bread. Popcorn can be used if over 4 years old.)
  • Limit milk products (milk, ice cream, cheese, yogurt) to 3 servings per day.

4. Stop Toilet Training: Temporarily put your child back in diapers or pull-ups.

  • Reassure him that the poops won’t hurt when they come out.
  • Praise him for the release of stools.
  • Avoid any pressure, punishment or power struggles about holding back poops, sitting on the potty or resistance to training.

5. Sitting on the Toilet (if toilet trained): Establish a regular bowel pattern by sitting on the

toilet for 10 minutes after meals, especially breakfast.

6. Warm Water for Rectal Pain: Warmth helps many children relax the anal sphincter and release a stool. For prolonged straining, have your child sit in warm water or apply a warm wet cotton ball to the anus. Move it side to side to help relax the anus.

7. Flexed Position:

  • Help your baby by holding the knees against the chest to simulate squatting (the natural position for pushing out a stool). It’s difficult to have a stool while lying down.
  • Gently pumping the lower abdomen may also help.

8. Call Your Doctor If:

  • Constipation continues after making dietary changes
  • Your child becomes worse


Dr Rahul Varma

Why Exclusive breast feeding is the best option for both mother and baby?

Besides below mentioned advantages, another point I want to make is ” breast feeding is cheapest,  most hygienic and most nutritious food for your child, which will help in better brain development and less chances of allergies and stronger immunity also “

Why breastfeeding is good ?

Why there is so much importance given to breast feed these days and what are its benefits to the baby and what are benefits to mother ? All  parents esp. the first time couples have this query. Few of the important points in this regards are

Benefits to baby:

  • Warmth to baby along with increased bonding between mother and child.
  • Easily digestible ( They say breast milk is “Tailor made as per requirement of your baby” )
  • No preparation is needed, ready to use.
  • Hygiene is maintain, no chance of contamination with micro organisms.
  • Best nutritious value i.e all the ingredient of balanced diet for baby.
  • Increases Immunity of your baby.
  • Prevents against allergies.
  • Prevents various Infections. There is less incidence of ear infections, cough, cold, loose motions and other serious illnesses in breast feed babies.
  • Best for optimum growth and development of your child.

Benefits for you (Mothers):

  • Pre Pregnancy figure achieved earlier and easily in mothers who opt to breast feed their baby. More calories is lost in breast feeding.
  • Natural Contraception. For 1st 6 months if Mother decides to exclusively breast feed child and her periods have not started, then high chance are there for natural contraception.
  • Less incidence of ovarian and breast cancers in breastfeeding mothers.
  • Increased bonding with their child.
  • Less incidence of emotional disturbances

Stay healthy


Dr. Rahul Varma

How to manage ear infection in children?

More than half if not three quarters of ear infections in children are caused by viral germs which get better simply with tincture of time.

Bacteria-causing ear infections do need treatment with an antibiotic but since these are in the minority as a cause, the American Academy of Pediatrics now suggests not treating ear infections in children over 6 months of age automatically with an antibiotic but instead treating the pain for the first day or two with the hope that the virus causing the infection will be defeated by the child’s own natural immune system and if the ear pain and discomfort persists after 48 hours despite good pain control, then antibiotics might be considered.

This delay in treating ear infections with antibiotics is to avoid overuse of antibiotics which can make the bacterial germs more resistant to common antibiotics and thus more difficult to treat.

Just because we may not prescribe antibiotics immediately does not mean we will not treat the pain with ibuprofen or acetaminophen.

Of course the best way to deal with an ear infection is not to let one happen, so what can we do to prevent them? The best way to do this is to teach your children good handwashing to prevent the spread of germs from one person to another.

In addition, breastfeeding your baby for at least the first six months, and making sure their immunizations are up to date decreases the risk of ear infections occurring and keeping children away from environmental tobacco smoke will make it easier for viruses to get out of the nose so they don’t move up into the ear canal and cause an infection.

Hopefully tips like this will give you more than an earful of information when it comes to getting a better understanding of your child’s ear infection.



Dr Rahul Varma

Is your child hyper active or difficult to manage??

Is your child hyper active or difficult to manage??

All children between 18 to 24 months should be screened for hyperactivity and Behavioral disorders like Autism etc. (as per recommendation of American Academy of Pediatrics).
It can be easily done in OPD setting using M- chat (23 point Questionnaire). it takes hardly 10- 15 minutes.. If positive, child can be referred to Child developmental specialist for detailed work up.
It is available at Maya clinic (No extra charges).

Feel free to discuss with our child specialist/Pediatrician.

The American Academy of Pediatrics (AAP) recommends screening all children for autism at the 18 and 24-month well-child visits in addition to regular developmental surveillance. This type of screening can identify children with significant developmental and behavioral challenges early, when they may benefit most from intervention, as well as those with other developmental difficulties. For screening to be effective, it must be applied to all children – not only those with Symptoms.

Modified Checklist for Autism in Toddlers (M-CHAT): In most offices, pediatricians use the M-CHAT, a 23-point questionnaire filled out by parents. Most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for ASD and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a child at risk with additional genetic , neurologic, or developmental testing.

Screening Isn’t Diagnosing!

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for an ASD, it doesn’t mean he or she will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about ASD, don’t be shy. Screening tests are just that—screening—and don’t identify all children with ASD. The rate of success for the M-CHAT, for example, isn’t 100%, so it is used in combination with health and family history to identify children at risk. Your opinions as a parent are irreplaceable and of the most importance.

If You Are Concerned and Your Child Has Not Been Formally Screened:

Talk with your pediatrician about doing a formal screening. Many screening tools are available.



Dr Rahul Varma

Chikungunya Fever: Not a life threatening illness but extremely painful condition


Chikungunya Fever:

Not a life threatening illness but extremely painful condition with bone pain so severe; which you might have never felt ever in life previously.


  •   Symptoms begin 3-7 days after mosquito bite. It is caused by day biting mosquito aedes ageptyi (same one which causes Dengue).
  •  Abrupt onset of high fever and severe joint pain (hands, feet, ankle, wrist, back etc)
  •  Across all age groups
  •  other features may include: headache, myalgias, conjunctivitis, weakness, maculopapular rash.
  • Most patients feel better within a week but some may feel the joint pain for months.
  • Lab test: Normal except for lymphopenia (low WBC or TLC)
  • Diagnostic test: (only after 5-7 days of illnes) ELISA based IgM for Chikungunya.



  • No specific treatment.
  • Adequate Rest
  • Plenty of fluids
  • Paracetamol . NSAIDS like Ibugesic and meftal etc ,should only be given after Dengue has been ruled out. (as NSAIDS increases chances of bleeding).
  • Prevent mosquito bite and breeding of mosquito around your surroundings.
  • Avoid self medications , it can be dangerous.

 transmission chikungunya chikungunya mosquitos

Death due to Chikungunya is rare.

  • It is not contagious i.e. it does not spread by touching or in close contact. (It happens in the family and close relatives because all are living in same environment where mosquito is breeding.)
  • Remember it spreads in clean water. (So do not blame poor and unhygienic conditions around you for everything).




Dr Rahul Varma

Febrile Seizure in Children; What to do?


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.


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)


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


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.


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.


Dr Rahul Varma