Prone to febrile convulsions - what do you do to bring/keep temp down?

[JustKeepSwimming]

A friend's DS has just had his 2nd febrile convulsion.
He is in hosp but should be fine :)

Have been discussing with her the way forward. This time she knew he was ill, knew he had a temp and was trying everything she could think of to bring it down to prevent it happening again but obv didn't work.

In hosp they've given him some Neurofen & basically said that's all there is

Is there anything better than Calpol + tepid water + clothes off + maybe eat ice-cream +.....?

No, in a nutshell.
Hospitals deal with high temps all day every day and not just with kids, and the best thing is paracetamol. Its the most effective treatment.
Your friend will learn how to deal with the convulsions at home and it wont be an issue and the kid should grow out of it soon anyway.

Thanks for replying - it just seems a bit mad to sit there with him having a high temp, having tried everything, waiting for the convulsion to happen :(

Paracetamol/nurofen suppositories. I have used these whilst dd was having a febrile convulsion.

DD used to have this problem. It made me a little paranoid and I used to give her Calpol if her temperature was slightly raised. I found that doing this before the temperature got too high worked well. It is such a worry when this happens and I hope your friend's son gets better soon.

calpol and nurofen interspersed (or together)

fan in room

strip off

take outside

Suppositories are best.
I also use vinegar - soak socks in cold water mixed with a lot of vinegar, wring out, put on feel, use a plastic bag to keep bed from getting all wet and stinky.
Repeat if needed.
works beautifully.

We found nurofen worked better and alternated that with paracetomal

Also I know some hate them, but the ear thermometers were a god send for me. I knew the minute we went past 39C I had a v short time to get the medicine in them before they starting heading towards 41C

Tbh I only ever stripped them off. Didn't find the sponging ever did much once they got so incredibly hot.

Belgo - are the suppositories available OTC? sound like they might work quicker.

She had been giving him everything at home and crossing fingers, then it happened anyway.

He's in a funny phase where he likes to keep his clothes on (!) so she 'accidently' spilt some juice on his pjs to get him to take them off, lol. Didn't help in the end either.

Vinegar socks - ok, will pass that on lol, never heard of it before!

Both of my nieces have convulsions. The risk isn't the temperature itself, it's the speed at which it rises. DN1 can fit at 37.7 degrees if she's rapidly reached it from 36.5. She won't necessarily feel hot either.

So, measures that slowly and consistently keep the temp stable is what's best. Anything that rapidly lowers the temp like cold water causes the immune system to fight back, shiver and try and raise the temp quickly (because a temp is a normal reaction to illness and the body is fighting to respond normally).

Cool air circulating (not a direct cold stream of air), stripped off, cool drinks, no duvets/blankets etc.

DNs also struggle with anti-pyretics. They often vomit them back up and then the temp spikes again and no more meds can be given.

It's worth remembering they're generally not dangerous. They look frightening but it's a safety mechanism that they will grow out of.

Fever reducing medicines DO NOT prevent febrile convulsions and the NICE guidelines do not recommend using them like this - only if the fever is causing discomfort. As SOH says, it is the speed of the temperature rising that causes the convulsion - not the height of the temperature.

Suppositories over the counter? for children? god i hope not, can u imagine!! ppl using them without being shown, heaven forbid!

That sould have read "put on feet". Of course.

The guidelines from the hospital is still to give paracetamal/ibroprufen. The NICE guidelines are to prevent overdose because they think everyone is thick and can't work out dosages themselves!
DS has GEFS+ and is still prone to febrile convulsions even though he is a teenager. I spoke to the consultant about it in February and she said that we should give him paracetamol/ibroprufen.
Unfortunately suppositories are really really expensive in the UK, although they are cheap in europe

Thanks everyone, friend has put on FB that he's had another one and temp it all over the place :(
Hopefully they'll get on top of it soon.

bruffin, the NICE guidelines are nothing to do with overdose risk. I've just sat and read through them all again to make sure. The evidence reviewed and the guidelines given are all based on there being no evidenced link between anti-pyretics and reducing the risk of febrile convulsions. And that in every test, alternating ibuprofen and paracetamol was never shown as having more effect than using one medicine over another.

Maybe it depends on the paediatrician and the actual child. DNs consultant paed advises only to give one medicine and switch to the other if it's ineffective. And he's always keen to recommend physical instead of pharmalogical measures as both DNs vomit up anti-pyretics anyway causing the spike that creates the convulsions.

"Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose."

From the NICE guidelines. Anti-pyretics should not be given solely to treat any fever. Of course you should give them for a child who is in discomfort from illness though.

JKS, hope he's better soon.

I spoke to my consultant specifically about this last week and her advice is still to give anti pyrectics for children who are prone to febrile convulsions. Most doctors do not agree with the NICE guidelines and there have been calls for them to be changed.

NHS guidelines also state not to give anti-pyretics solely for fever, as do most doctors I know. Generally though a fever presents alongside other symptoms that do require medication.

I think if your child suffers from febrile convulsions then you take advice tailored for your own child. If you can consistently keep the temp down by either pharmacological or physical methods then you're less likely to see a child convulse but because a convulsion isn't actually caused by a high temperature, reliance on anti-pyretics or belief in abilities they don't have, won't actually prevent convulsions. They help with the course of an illness, they help with stabilising a temp that might be causing problems but they cannot prevent convulsions and cannot be believed to do this.

You specifically stated that the NICE guidelines are what they are because they think parents are thick and because of overdose risks. This simply isn't true.

The NICE guidelines state not to give mixed alternating dosages because of the risk of overdose, and because it is not clinically proven to be effective.
I read that as parents are too thick not to overdose their kids.
I also read not clinically proven to be effective as not clinically proven to be ineffective!

I have read both these statements in the guidelines.

GPs usually advise alternating whether it fits the guidelines or not, and it is unreasonable to expect any parent whose child has fitted not to do everything they feel they can to prevent these happening regardless what the research says, providing they are not harming the child. We also gave max dosages of both in A&E to a feverish child. I am not advocating dosing them up to the eyeballs, but to give something 4 hourly as a minimum to keep the fever down and to prevent the discomfort felt with a high fever.

There is more up to date research than the NICE guidelines which advocate a sensible approach.

www.bmj.com/content/337/bmj.a1302.full

Worth while reading

He had 2 more, one whilst in A&E but seems better this morning thankfully.

Fingers crossed that's the end of them for him.

Hope there is no serious underlying cause as they do tend to be one off terrifying episodes. I guess as he's a bit better today he should be fine, but obviously one of those LOs who are prone to them

Yep, I saw him this morning, totally fine & normal thankfully.

She's been told he'll grow out of them about 5yrs old - didn't mention someone said their older DC still had them (sorry can't remember who).

I am just back posting but should anyone need an expert on this, I have a grimy T shirt. Possibly white, but seems liek GH has stuck in with a coloured wash. Typical.

My 3 have all done this from repeated and mild (DS3, 6 times) to long and hard (DS1, 2 weeks before 5th birthday and for 40 minutes). 30 mins is enough for brain damage. He certainly is not (Can I get him off his Kindle to do laundry, aged 11?)but needed so much valium to stop fitting, the next step would have been to stop his heart, that I thought he was brain damaged as he could not talk properly for 2 days.

My advice is dose, dose, dose as it may not be the answer if they are doing spikey temperatures which brings it on but it is better than the alternative.

And get some Calpol suppositories and know how to use them. Vaseline, wet the end, get a nurse to show you. You are not a paedophile (blokes uncomfortble with this, understand) I had some left over from DS1's spiral fracture of his femur and hospitalised for 6-8 week when we lived in Malmo, 6 weeks before my planned homebirth of DS2, life on the relative edge. They came in v useful as DS2 (a v confuing timeline) was the first to go at about a year old.

DS2 started fitting first thing in morning after his christening. His glow that day was not religious (sorry very RC Mum). I think he went a week later at 5 in the morning. Lucky to have a BF who is a Modern Matron. Her advice was to give him a suppository and I could see him twitching.

I went for it, getting the bum pills from the bathroom cupboard. They work so quickly. I could see him starting to go and then do this 'Ahh' moment, thats better and settle. I did not realised what a moving moment it was to be. I get tearful looking back. I would never have had suppositories to hand if not the trauma of DS1. I would not have done so without the advice that I don't think NHS direct would have done (2 aspirin and a lie down or why don't you go and see your doctor? Don't get me started..)

My GP would always complain when I asked for a repeat prescription (they are about £10 for 10) and seemed to think I never gave oral calpol/nurofen which was bemusing. If I had demanded those on free prescription (please don't try) the cost would have looked like a cottage hospital. Twitfoolery in comparison to calling out an ambulance which I always did to at least get oxygen on them.

Anyhow, my boys have grown out of (which they do at 5) but do get refer to me if necessary.

Do also get an ear thermometer and know all your normal temperatures. The MalmoHeights lot tend to a low base temperature of 36.5 C. When they hit 37 (normal for the rest of the population) I went for nurofen first. Calpol is better at getting temperature down but i have that as a suppository so my second line of defence that I can do before I called an ambulance. (it makes sense even given my irish roots).

MalmoMum

DD has these and they unfortunately become generalised seizures in her due to brain injury at birth. We have had her seize at 37.5 degrees but be ok (although very poorly) at 40.1 degrees.

It is the speed at which it rises and not the temperature itself. We have to call 999 every time and we have a drug called Midazolam to stop them if they go over 5minutes. The worst lasted an hour and did sadly cause additional brain trauma and she was paralysed for several days and long term lost the use of her right side. I must stress this is most likely to be due to the initial birth injury.

However we were told to alternate Nurofen/Paracetamol by our neurologist and we do that as soon as we see she is ill. We have digital thermometers and a large fan which cools the air in her bedroom although when ill she sleeps on my tummy or right next to me and we are careful about hand washing and infection risk. AKA I am a neurotic first timer with an ex NICU baby!

Sounds like she is doing all she can as a mum, DD gets them with throat infections - never ear infections.