Febrile Seizures: What to Know

Fevers scare parents. We worry about how sick our children are and if that fever means something more serious. But for some kids, a rapid spike in fever can cause something called a febrile seizure. And although febrile seizures are usually not dangerous, they are certainly very scary. Keep reading to learn more about febrile seizures.

What is a febrile seizure?

Febrile seizures are seizures that happen when a young kiddo has a fever. Most febrile seizures are generalized which means that your child will lose consciousness and have jerking of arms and legs. Febrile seizures do NOT mean that your child has or will have a seizure disorder. (Epilepsy is considered when your kiddo has recurrent seizures that are NOT attributed to fevers.)

Most kids with febrile seizures are between 6 months and 5 years old. The peak age is around 2 years. They can happen to anyone. Most of these seizures are brief and last only a few minutes. (Although if it is happening to your kid, it will feel like eternity.) Up to 5% of children will experience a febrile seizure before their 5th birthday.

Will it happen again?

Maybe yes, and maybe no. Most kiddos who experience a febrile seizure will never have another one. But there are some risk factors for having recurrent seizures.

  • Less than 18 months when experience first febrile seizure
  • Family history of febrile seizures
  • Lower fever at time of seizure
  • Having a seizure as the FIRST sign of illness

What if my child has a febrile seizure?

Although febrile seizures are not usually dangerous, it is important to get your kiddo checked out. What you need to do depends on a few things.

The seizure is lasting more than 5 minutes…

If your child is having a seizure and it is lasting more than 5 minutes, you need to call 911. Although a prolonged seizure is not necessarily dangerous, your child needs an urgent evaluation and transport to the nearest hospital. The doctor will need to make sure what is causing the fever is not serious.

The seizure lasted less than 5 minutes…

If your child has a seizure lasting less than 5 minutes and seems ok now, they need to be checked out. Call your doctor and see how they would like you to proceed.  Many times, especially if the office is open, a trip to the ER isn’t necessary. But, your child does need to be checked out and the cause of the fever evaluated.

My child isn’t acting right…

If your child has a seizure that lasted less than 5 minutes, but they aren’t acting right, they need urgent medical attention. Call 911 for transport to the nearest hospital. Changes in mental status should always be taken very seriously.

My child had a seizure but they’re acting fine…

If your child had a seizure but they came out of it on their own and are now acting totally fine, call your pediatrician’s office to see how to proceed. They will need to be seen and many times, a trip to the ER is not necessary.

What do I do if my child is having a seizure?

If your child is actively seizing, there are thinks you can do to minimize the risk of injury.

  • Lower your child to the ground and lay them on their side or belly to decrease risk of choking
  • Move any nearby objects that your child could hit possibly injuring themselves
  • DO NOT attempt to put anything in your child’s mouth
  • Peak at your watch or nearest clock to see what time it is. If the seizure lasts longer than 5 minutes, call 911
  • Once the seizure has ended, bring your kiddo in to the doctor to be evaluated

Where can I learn more about fevers and febrile seizures?

Luckily, there is a lot of information out there if you’d like to read more about febrile seizures.

Here is a great fact sheet from the NIH.

For information on what a fever is, you can read Fever: What it is and when to worry.

It’s the Flu

Tis the season for all things warm and cozy. Holiday preparations are ongoing and there is a festivity bubbling under the surface even in mundane daily activities. But with all the family gatherings and celebrations, it is also the season of illness. Although the seasonal flu may not be knocking at your door yet, it will be here soon. Do you know what to do when “It’s the Flu”?

What is the Flu?

The flu is a respiratory virus. It peaks each year between November and March. The flu affects the nose, throat, and lungs.  Most cases of both type A and B influenza virus are uncomplicated and consist of typical flu symptoms as follows:  High fever, sore throat, cough, congestion, muscle aches, chills, and headaches.  Symptoms of the flu usually last 3-5 days.

How do you get the flu?

The flu is spread thru tiny droplets that are spread when we sneeze or cough. We also spread tiny droplets from talking. If these little droplets land on a hard surface, they can live for 24 hours potentially infecting anyone else who touches them. Gross? You betcha.

To make matters worse, we are contagious for a full 24 hours before we even show signs of the flu. Once you’ve come into contact with the virus, symptoms develop 1-4 days later. Anyone else feel like disinfecting their homes?

What’s the big deal?

We hear about viruses all the time.  So what’s the big deal about the flu? Unfortunately, all cases of the flu aren’t mild. Some kids (and adults) get very sick very fast. And some kids die. 80,000 Americans died from seasonal flu last flu season.  Does this scare you?  As a pediatrician, it scares me. I work every day to try to protect other people’s kids. I don’t like giving bad news. When my patients or their parents die, I mourn and always remember them. As a mom, it scares me. Flu is just as likely to kill a pediatrician’s kid as anyone else’s.

Some people are higher risk for complications from the flu. Chronic illness? Asthma? Pregnant? Babies? Elderly? All at high risk. But the flu will also kill totally healthy normal people too. It does not discriminate.

What can you do for prevention?

You cannot totally prevent getting sick, but you can certainly lower your odds of illness and at the minimum, of complications.

Flu shot

Get your flu shot. Does it always work?  Nope, afraid not. But it’s the best we’ve got. 80% of child deaths from the flu last flu season were in unvaccinated kids.  Last year, the flu shot prevented illness in only 20-40% of those vaccinated. I’m well aware of this. After a stellar flu-free run in my home, our stats came crashing down last year when BOTH of my kids ended up with it. We should have purchased stock in Lysol and tissues.

Healthy Habits

This sometimes feels like a lost cause in kids, but it’s never too early to start teaching healthy habits. Since influenza virus can live up to 24 hours on hard non-porous surfaces (tables, toilet handles, doorknobs, light switches), it’s best to minimize the amount of virus that makes it there.

If you can get your kiddos to sneeze or cough into a tissue, that is the best. Flu virus only lives for 15 minutes or so on tissues. You can read more about that here.  But if tissues aren’t readily available, sneezing or coughing into the elbow works decently too. Influenza virus lives 8-12 hours on clothes.

Sanitize

Unless you are a super-sanitizer-extraordinaire (not me), it will be difficult to keep the virus exposure to zero. But you can cut down on germs in your home by hitting the heavy touch points, especially if someone in your house already has the flu.

Think about the places that lots of fingers touch frequently and disinfect those. Refrigerator and sink handles. Pantry doors. Doorknobs of entry ways and into bathrooms. Light switches. Toilet handles.

How is flu diagnosed?

Flu is diagnosed most often through rapid screens performed in the office from a nasal swab.  These tests are less accurate later in the disease process.  If the flu is rampant in the community and the patient has all the right symptoms, the doctor or practitioner may diagnose clinically rather than with rapid testing.  Results from the first 72 hours of illness are the most accurate.  False negatives can and do occur.

When to worry

Although most cases of the flu are uncomplicated, we are always concerned with development of severe symptoms or secondary infections.  Common complications from the flu include pneumonia, otitis media (ear infections), and sinus infections.  Serious complications such as influenza associated myocarditis are rare, but can and do happen.  Most secondary infections are easy to treat, however, serious invasive infections can occur resulting in hospitalization and in some cases, even death. Children younger than 5 years old are at increased risk for complications from the flu.  There is also an increased risk in children with chronic disease (asthma, diabetes, congenital heart disease, hemoglobinopathy, cystic fibrosis, chronic lung disease, and chronic renal disease).

If things seem to be taking a turn for the worse, go back in to see your doctor. Any difficulty breathing should be taken seriously. If your symptoms seem to be improving and then start worsening again, you may have developed a secondary infection.

Treatment

Treatment of flu is primarily comfort care.  Tylenol and ibuprofen (in children > 6 months) can be given for fever.  Aspirin should NEVER be used in children due to risk of Reye’s syndrome.  Tamiflu is recommended for children with flu who are younger than 24 months old.  Tamiflu must be started in the first 48 hours of the illness.  Children with chronic illness (as listed above) may also be treated with Tamiflu.  Children who live in households which include other individuals at high risk may be considered for treatment as well.

Tamiflu is NOT recommended for all children and adults with influenza.  Nausea and vomiting are the most common side effects from Tamiflu.  However, there are also more serious side effects that are possible. Hallucinations, confusion, and unusual behavior are among the less common side effects. If your child has any strange symptoms while taking tamiflu, make sure to let your doctor know.

You should also know that tamiflu decreases the duration of flu symptoms by 1-2 days.  But it doesn’t make you feel better. Only time will do that.

Supportive care remains the best treatment for influenza. The Cold and Flu Survival Guide gives ideas for helping your littles (and you!) feel better. Information about fevers can be found here.

What about elderberry syrup?

There’s a whole lot of buzz lately about using elderberry syrup to prevent and treat illness. Unfortunately, there is not a whole lot of science to back up the claims. Many of the available preparations are syrup and contain a lot of sugar. A Pubmed study, Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections, does suggest that use of elderberry syrup may decrease length of influenza. But it was a VERY small study. More research is needed.

Final Thoughts

The flu can be scary. Noone likes being sick or having sick kids. Missed work and missed school can be big inconveniences. Knowing what to expect and what to do can help. If you’re not sure how prevalent flu is in your area, you can check the CDC flu activity map.  It gets updated weekly and you can get a good idea of how much flu is in your area. As always, check with your pediatrician if your child is sick and seems to be taking a turn for the worse. We never mind the questions. We love your kids too.

Postpartum Depression

You’ve spent the last nine months preparing for your new bundle of joy. Juggling work or other kids. Keeping up with your daily responsibilities all while managing the extras that come with growing another human. It’s a lot to take in. Now you’ve brought home your baby. By all accounts, you are supposed to be gloriously happy. And you ARE happy. But sometimes things are just not right after giving birth. Sometimes you can’t shake the anxiety or underlying sadness. How do you navigate when your expectations and reality don’t line up? Fifteen percent of women experience postpartum depression. Are you one of them?

The Reality

Childbirth (and pregnancy!) is not all rainbows and unicorns. Sometimes things go wrong. Miscarriages are common and often not discussed. And there is an ever-growing list of things that you should and should not do while pregnant. We live with the illusion that if we do everything right, if we can control all the variables, we can protect ourselves and our babies. But if you are struggling, you are not alone. In fact, you’re in good company. Up to 80% of moms experience baby blues. And 15% will experience more severe symptoms of postpartum depression.

Signs of Postpartum Depression

  1. Feelings of significant anxiety or sadness that are interfering with your ability to take care of yourself or your family
  2. Crying more than usual or for no apparent reason (BTW, dads LOVE this one… I once started bawling my eyes out when my husband brought me home lunch a couple of weeks after bringing my firstborn home from the hospital.)
  3. Losing interest in things you normally love
  4. Thoughts of hurting yourself or your baby
  5. Feelings of anger or rage, feeling out of control
  6. Noticing that you are having trouble bonding or feeling connected to your baby

What is the difference between baby blues and postpartum depression?

Many women experience baby blues. As I mentioned above, nearly 80%! So more of us than not will have some feelings that don’t easily line up with what we are expecting? Lots of stuff goes into this. Sleep deprivation and pain do not help. And I’ve not yet met a new mom who doesn’t have at least a bit of both going on.

Baby blues often start within the first week of giving birth. They are mild enough that they don’t interfere with your ability to hold it all together. And they usually go away on their own within a week or two. Postpartum depression is more significant. It can start any time after childbirth and affects a mom’s ability to get through her day. A mom with postpartum depression may find herself utterly exhausted, but unable to sleep worrying that something might happen.

Who’s at Risk?

Postpartum depression can affect anyone. It doesn’t care about your race or socioeconomic status. It can hit anyone from anywhere. But there are some risk factors that make you more likely to experience it.

  1. History of postpartum depression with another child
  2. A personal history of anxiety, depression, or bipolar disorder (past or present)
  3. A family history of mental illness (anxiety, depression, or bipolar disorder in particular)
  4. Personal history of drug or alcohol abuse
  5. Lack of social support system
  6. A stressful event occurring during your pregnancy or shortly thereafter. This could include a family death, unexpected complications with the pregnancy or delivery, or loss of family income.

How can you know if you have a problem?

This is one of those things that is easier to tease out after the fact sometimes. While you’re experiencing it, it can be difficult to recognize. It is really easy to put on a happy face for the world and pretend everything is just fine. I know this because I’ve lived it.

My Story

My first pregnancy ended in an early miscarriage. I was a nervous wreck when I found out I was pregnant with my firstborn. I had finally started to relax and feel safe around 19 weeks when the contractions started. We were certain I was just overreacting so lots of water and extra rest. It didn’t get better. When I started timing them and realized that they were regular and frequent, I went to the hospital. I was in pre-term labor. IVs, magnesium, Terbutaline, Procardia, monitors. It was terrifying.

We made it through that hospitalization and several others before finally delivering a healthy baby girl at 37 weeks. It took around the clock medications, bed rest, and weekly perinatology visits. I put on a happy face for the doctors. But when I got home from the visits I would cry. I couldn’t think about the baby and I didn’t want to plan for her.

The experience took a toll on me. By the time I delivered my baby, I had no muscle strength.  I couldn’t sleep at night waiting for her to wake up. And during the day, I couldn’t stay awake. I’d used up all my leave during my pregnancy, so I had to return to work when she was just 4 weeks old. I chalked up all issues to normal new mom stuff. Months passed before I started to feel half-normal again. And eventually I found my new normal. But when I look back at those first few months, what I remember is the bone-deep fatigue, the anxiety of waiting for something else to go wrong. I needed help. But I didn’t recognize it. And I didn’t know how to ask for it.

Screening tests

Fast forward nearly 14 years and we have a much better understanding of postpartum depression and postpartum anxiety. And many pediatricians routinely screen for it when seeing parents with babies under 6 months of age. In my practice, we give a screening tool called an Edinburgh at the 2 week, 2 month, 4 month, and 6 month visits.

Sometimes when I walk into a room, everyone looks great.  Mom is put together and smiling and seems appropriate. And then I look over her Edinburgh screening and realize that she’s not ok. Which is when I will say that the screening tool looks like she may be struggling more than is necessary. And the tears start. Turns out I’m REALLY good at making people cry. It’s my super-talent. But good things come after that. Sometimes we have to reach the bottom before we can claw ourselves back out.

If you are reading this and it is resonating with you, ask questions. Talk to your doctor. Ask your pediatrician. If you’re a fan on online quizzes, you can insert your answers to this online Edinburgh Postnatal Depression Scale. Print out your results and use them to talk with your doctor.

Getting help

If you are having trouble, there is no shame in asking for help. And although you may be feeling alone, you most certainly are NOT. Talk to your OB/GYN. Ask your little one’s pediatrician. Your doctors can help direct you to the next best step. We need healthy moms for healthy babies. You are important, so take care of you.

Resources

For further reading, you can check out the following resources.

  1. National Institute of Mental Health:  Facts
  2. Mayo Clinic: Overview
  3. Office on Women’s Health: PPD
  4. See PPD: About PPD
  5. Postpartum Support International: PSI Online Support Meetings

It’s A Virus

“It’s a virus.” We all love this answer (NOT!). When your kid is sick for the up-teenth day and you are starting to feel the heat at work, what you really want when you bring your kid to the doctor is for it all to go away. We’ve all been there. It’s hard to keep everything together on a GOOD day. And throwing in a virus is not welcome. Read on for more on this frustrating diagnosis.

“So you don’t know what it is then.”

Well, not exactly.  There are gazillions of different viruses. And they are constantly shifting, changing, and mutating. (If you want a quick refresher course on what viruses are, you can read more about it in this Khan Academy introduction.

There are lots of tests to identify exactly WHICH virus. But here’s the thing. Tests are expensive. And many take days to come back. By the time you know your child’s cold was caused by a rhinovirus, they’re already improving. Health care costs are expensive. Most of the doctors I know work really hard to use your resources wisely.

It is much preferred to order expensive tests only when the answer has the potential for changing what we do and how we treat.

Being able to say which subtype of adenovirus your child has is not really all that helpful. Often, there are specific clues that will tell us the most likely culprit.  And many times, the big offenders change by season. But knowing you have a metapneumovirus instead of a coronavirus isn’t useful information. Neat. But not useful.

“So there’s nothing you can do?”

Not exactly. There is nothing we can do to make a virus go away sooner than it is going to go. There ARE things we can do to help our kiddos feel better. Tylenol (acetaminophen) and Motrin (ibuprofen) can help bring down fevers. Check with your doctor on proper dosing for your kid. Saline spray can help break up thick mucous in your child’s nose. Honey will help a cough. Warm liquids soothe a sore throat. Extra snuggles give reassurance. Check out my Cold and Flu Survival Guide for a list of items to keep on hand.

Sometimes time and patience is the best medicine. And sometimes doing “nothing” is the best thing you can do. I know it’s not what you want to hear. And I know it is small consolation, but I don’t like to say it either.

It’s your pediatrician’s job to tell you what you need to know, not what you want to hear.

And please understand that we desperately want your kiddo to feel better sooner too. But wants don’t always change reality and we can’t always have what we want. (Darn it, my parents were RIGHT!!)

“Can’t you just nip it in the bud?”

Nope, afraid not. I have nothing at my disposal to make a viral infection go away sooner. If your kiddo is in the first day or two of a virus, it is probably going to get worse. You don’t like it. I don’t like it. But that’s how it goes sometimes.

Antibiotics are not helpful for viruses. They help bacterial infections. And antibiotics are not without side effects. Rashes, upset stomach, diarrhea, vomiting. And if that’s not enough, we have resistance to antibiotics to contend with.

As parents (and pediatricians) we can give supportive care. Keeping your kiddo hydrated and comfortable is that best thing we can do.

“But Susy’s kid did this exact same thing and then it turned into an ear infection”

Our bodies work hard to fight off viruses. Most of the time, the infection fades away and we go back to our normal everyday lives. But sometimes we end up with what docs refer to as “secondary infections.”

Secondary infections are infections that grab hold while we’re already knocked down from something else. They’re not all bacterial. It’s completely possible to come down with a stomach bug while fighting off a cold.

But some secondary infection are bacterial. Ear infections and pneumonia are a couple that can be bacterial secondary infections. (Although both of these also have viral forms as well.)

Unfortunately, there is no way to predict which of our kids will go on to have a secondary infection. So if that fever is hanging on past 5 days or they were improving and now they’re sick again, get them checked out.

“I brought my kid to the doctor and they did nothing and said he had a virus.”

Sometimes value comes from ruling OUT and not ruling IN.  A diagnosis of a virus means that the ears aren’t infected. There is no strep throat. The lungs are clear and there is no pneumonia. There are no swollen organs.  There is no evidence of cancer.

It is easy to be worried as a parents. Many of us are parents too. Sometimes the doctor part of my brain has to talk down the parent part of my brain. I get it. But sometimes “doing nothing” is the absolute best thing to do.

What questions do YOU have about viruses?