Febrile Seizures

A very common and frightening condition of young childhood is benign febrile seizures (BFS), defined as a seizure episode associated with febrile illness not involving the brain.  This condition effects 2-5% of children ages 6 mo-6 years, predominantly those under 18 months.  They are more typically of short duration(< 10 minutes) and “generalized,” meaning the child will briefly loose consciousness and the entire body will shake.

Febrile seizures are usually simple–lasting no more than 15 minutes (usually no more than a minute or 2) and subsequently the child will wake up and be fairly alert. “Complex” febrile seizures are longer, may be multiple during one illness, and/or display “focality”–predominantly one limb or one side shakes. The most important word in the above diagnosis name is BENIGN. They do not seem to have risks of serious neurologic disorders compared to others-problems like ADHD, hearing deficits, learning problems or developmental delay.  2-10% will develop epilepsy, about the same as the general population. Those with “complex” febrile seizures, those with developmental delay or underlying neurologic problems like cerebral palsy do, unfortunately, have a somewhat greater risk here.  In these instances, the seizure episode is felt to be more a marker as a tendency towards epilepsy as opposed to merely an isolated event.

Most children with BFS will only experience a seizure episode a very few times–only 1/3 will have more than 1, and fewer than 10% have more than 3.   Children who are less than 15 mo old, have frequent fevers, family history of epilepsy or febrile seizures, short time between onset of fever and seizure, or seizure with lower level of fever make up the cohort at risk for more frequent occurrences.

Children with BFS should receive more aggressive fever control during acute illnesses.  Keep ibuprofen available, as well as acetaminophen for both oral and rectal administration –in case the child will not or cannot take medicine orally(say, during a seizure).  Tepid baths, cool liquids to drink, appropriate light clothing are all helpful.  Acute use of anti-seizure medicine is occasionally employed but mostly we try to avoid that route, at least for those in the “simple” benign febrile seizure category.  The incidence of complications from these medicines, while quite low, is still higher for most BFS children, and, as we doctors say, “the cure should never be worse than the disease.”  Use of these medicines daily to control the problem is reserved for those with complex febrile seizures under the care of a child neurologist.

Though certainly terrifying to witness, parents should try and keep in mind that in the very large majority of children with BFS this disorder will just go away in time and their child will grow up healthy and normal.  If you have questions or concerns about benign febrile seizures and your child be sure to contact me, and thanks for following.

The Over Achiever

Typical parent’s frustration: aimless, lazy child. Doesn’t want to go to school or do homework, avoids or procrastinates with chores, whiles away hours aimlessly on video games or social media. “The idle mind is the devil’s playground.”

As with everything, too much of a good thing is problematic as well.   The other end of the spectrum: the intense, hyper-focused child who has to take every AP and ace EVERY test, play every sport(often simultaneously) and ALWAYS finish first, works long hours in after school jobs to buy a new car that an adult professional might envy.  We know that type as well.

As parents and (for me) the pediatrician, we must be on guard for that troubled lifestyle as well. It is essential to teach children as they grow into adolescents and young adulthood the value of ambition and the pitfalls of perfectionism. The latter causes internalized stress and disruption of normal life functions like rest, relaxation, unstructured recreation, fulfilling family and peer relationships.  Their aspirations(and at times there isn’t even anything specific identified) can become totemic goals that may or may not be attainable but ultimately are largely besides the point.  One need not have all the highest grades to get into a good college and achieve career success.  Athletic scholarships are nice but uncommon, and the vast majority will pay at best a modest portion of college costs.  Over the years I’ve seen many more overuse injuries from hyper-training end young athletic careers than scholarships attainted.

And let’s not forget another fraught psychological component: we as the adults cannot and must not seek to redo our own missed opportunities, disappointments, or failures(or successes!) through them.  We’ve had our youth–its a fool’s errand to try and live their’s.

So what to do?  A few simple suggestions:

  1. Failure is fine.  Always try your best, but people fail. It happens, it’s a good teacher and a great way to learn fortitude as well as strategies for success next time.
  2. Perspective–have self awareness.  As an example: there are few D1 NCAA basketball players at 5’7″ and NOBODY in the NBA like that now.  So your slick ball handler should try hard but remember those realities. I say: play D3, start a business, make millions and BUY the NBA franchise. Therefore:
  3. Varied interests–play different sports, pursue different interests( music, volunteer). A well balanced life. I hate to admit this, but lighthearted, unfocused entertainment–video games with friends–is OK (moderation!)
  4. Rest–adolescents need > 8 hours sleep nightly. If her day is so crammed that she isn’t sleeping that much MOST NIGHTS she is over-scheduled.  Time to step in and:
  5. Be Parents!!  Teach them specifically the above. Enforce rules that promote those principles as you would to prevent laziness or disrespectfulness. Engage with them and be involved–and NOT only with that (perhaps over) focused sport.
  6. Watch out for warning signs: sleeplessness, fatigue, social withdrawal or isolation,   prolonged bouts of irritability, negativity, or hopelessness, panic attacks, weight loss (especially girls).

I tell my very ambitious teens: don’t go looking too hard for adult responsibilities–they will find you soon enough anyway.  Be a kid: when you are older you’ll want to be one again.

If you have concerns about these tendencies in your children please give me a call.  Thanks for following