Siezures, Colds, and Pertussis – Pediacast 012

Posted by Dr. Mike on October 9, 2006

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Topics

Febrile Seizures
Spreading Colds
Pertussis
Osgood Schlatter Disease

Transcription

Announcer 1: This is PediaCast, episode 12 for the week of October 9th 2006.

[Music]

Announcer 2: Hello moms, dads, grandmoms, grandpas, aunts, uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from BirdHouse Studios, here is your host, Dr. Mike Patrick Jr.

Dr. Mike Patrick: Hello, everyone and welcome to this week's edition of PediaCast, a pediatric podcast for parents. This is Dr. Mike Patrick Jr. coming to you from BirdHouse Studio and I'd like to welcome everyone to the program. This week on the show we're talking about Febrile Seizures, Spreading Colds, Pertussis and Osgood Schlatter Disease.

Now don't forget if you have a topic you would like to address on PediaCast you can submit your request on the Contact page of our website. Simply go to pediascribe.com/podcast and click on the Contact link. You can also reach us by emailing podcast@pediascribe.com or by calling our voice line at 347-404-KIDS, that's 347-404-K-I-D-S.

If you like PediaCast you may want to check out our blog at pediascribe.com. We also feature a weekly newsletter called PediAlert, which will keep you up-to-date with the happenings at PediaScribe and PediaCast, as well as E-breaking news from sources you trust like the American Academy of Pediatrics and the Centers for Disease Control. To sign up for our newsletter, simply go to our blog or our podcast page and click on the PediAlert link.

Also on both the PediaScribe and PediaCast websites we have a new link on there for an audience survey, so if you have a few extra moments, it just takes about five minutes or so to complete the survey and you can let us know what we're doing right, what we're doing wrong, what we can improve, what you'd like to see on the program. So if you don't mind taking a few minutes out to take the audience survey at either PediaScribe or PediaCast.

Also the FDA has come out with the update with the spinach story that we had last week, "The spinach supply is now safe," declares the FDA. So I can hear a collective sigh of relief from all the spinach loving kids out there, right? Oh boy!

All right, before we get started with our first topic, let me remind you that the purpose of PediaCast is to discuss topics of interest to parents and families. When we talk about medical issues it's in a generic sense. We do not address specific problems in specific children because there's no substitution for a face-to-face interview and hands-on physical examination in determining a diagnosis and formulating a treatment plan. Therefore, if you're concerned with your child's health you should call his or her doctor to discuss the problem.

And the views and advice expressed on PediaCast are my own and should not be considered the standard of care because medical variations which taken to account individual circumstances may be appropriate.

03:05

OK. On to our first topic and this is the infant segment of our program we're going to talk about febrile seizures. Now febrile seizures are the most common of the childhood seizure disorders. And we can divide febrile seizures up in to three types – simple, complex and symptomatic – and we're going to talk about the definition of each of these.

A simple febrile seizure occurs in the presence of a fever in children who are between the ages of six months of age to five years of age. Now the seizure is a generalized tonic-clonic seizure that lasts for less than 15 minutes. Now what is a generalized tonic-clonic seizure? Well generalized means basically the whole body is involved, so you're going to have both arms and both legs involved with the seizure; and tonic-clonic just means that you sort of go between shaking and stiffness. So shaking and stiffness of all four extremities will be a generalized tonic-clonic seizure and in a simple febrile seizure that's going to last for less than 15 minutes.

Also, in simple febrile seizure the child can have no history of significant neurological problems and the neurological exam after the seizure episode is over should be normal. And in addition to that, the fever, itself, cannot be caused by meningitis or encephalitis. Meningitis being an infection and inflammation of the fluid that surrounds the brain and the membranes that surround the brain and encephalitis would be an infection and inflammation of the brain, itself. So the source of the fever cannot be from meningitis or encephalitis in order to count it as a simple febrile seizure.

Now a complex febrile seizure, the seizure now is going to be focal rather than generalized, so that means only one part of the body is shaking or stiff, so like one arm or one leg. That is actually worse than if the whole body is doing it because that usually means it's not a seizure that is just from the fever and that perhaps there's something else going along, too.

Or if the seizure is really prolonged or greater than 15 minutes or if you have multiple seizures in a row. So the whole seizure episode is over and then there's another one a short time later that would now count as a complex febrile seizure.

Symptomatic febrile seizures are ones that occur when a child has a preexisting neurological abnormality. So if they have cerebral palsy or some sort of a central nervous system or nervous disorder of the brain then it would count as a symptomatic febrile seizure. Also if the neurological exam after the seizure is over is abnormal then it would be symptomatic or if a child has meningitis or encephalitis at the time of the fever and the seizure then it would go on to that symptomatic febrile seizure category.

05:53

Now what causes febrile seizures? Well the current thinking suggests that febrile seizures actually occur as a result of a rapid rise in temperature after a long period of temperature stability in a person with a genetic predisposition to this happening.

OK. Let me stop and back up. Basically, you have a long period of temperature stability. So kids cruising along 98, 99 degrees for months, then they get sick and suddenly they go from being 97, 98, 99, (Bang!) up to 102 in a short period of time. And that happens in a person who has a family history of febrile seizures then that be as a sort of thing that can make a kid have a febrile seizure.

So we don't think it's the ultimate height of the fever that does this. It's not the temperature being so high it causes some sort of brain damage. It's really more like a reboot of the brain, so to speak, when the temperature rises quickly and as the brain sort of reboots you have stiffening and shaking of the extremities very briefly.

For many kids the seizure's the first sign of the illness because it happens right there with that first temperature spike. So a parent may see that their child's having a seizure and then feel them and they feel hot to him. So once a child has a fever already it's much less likely that they're going to have a febrile seizure at that point, not impossible, but much less likely. It's usually with that first temperature spike with the illness that you see it.

Now in the United States, two to five percent of children ages six months to five years of age have febrile seizures and of these kids 70%-75% of them are going to be simple febrile seizures. So they're going to be ones that are generalized, all four extremities, two arms and two legs are involved and the child has a seizure that lasts less than 15 minutes.

Twenty to twenty-five percent are going to have the complex form, so lasting more than 15 minutes or only having one part of the body involved with the seizure. And then five percent of them are going to have symptomatic febrile seizure. So they have an underlying neurological problem or meningitis or encephalitis as the cause of the febrile seizure.

08:14

Children who have had one febrile seizure are more likely to have another one and this just speaks for the fact that there's a family pattern with these things. One-third of all children who have a febrile seizure will have another one at some point before age five. Of course that also mean two-thirds of kids who have a febrile seizure will never have another one.

If the first febrile seizure happens before 12 months of age then the chance of another febrile seizure at some point before age five is about 50%. If the first febrile seizure is after age 12 months then the chance reduces to about 30% that there will be another febrile seizure after that.

OK. Kids with a history of febrile seizure also have a slightly increased risk of epilepsy and epilepsy is a chronic seizure disorder. The rate of epilepsy for kids with a history of febrile seizures is around 2.5%. Of course that means that you have 97.5% chance of not developing epilepsy if you've had a febrile seizure. So it's still a very small number but 2.5% is twice the risk of the general population so it is slightly increased.

What do you do the first time a seizure happens? Well first thing you want to do is address your child's ABC, so that would be airway, breathing and circulation. And if you don't know what I'm talking about with this I really highly suggest that you consider a CPR class at your local Red Cross. They're easy to get in to, they'll take you an afternoon and you'll feel a lot more comfortable with performing CPR and taking care of airway, breathing and circulation, not just for your own kids but if you're out and about and something happens to someone you'll feel a lot more comfortable about it. So I would really recommend that for everybody if you have kids at home, really everybody in general.

10:09

OK. You also want to make sure that your child is in a safe place during a seizure, so on your lap or on the floor, away from objects. You don't want them up on a changing table or on the couch or the bed because of the risk of them falling off.

If there's breathing problem, such as apnea or they're blue in the face, you want to yell for help, call 911, if they haven't stopped breathing and if they're not blue in the face and the seizure, itself, is a simple febrile seizure so it lasts less than 15 minutes and they didn't have a neurological problem before that, you don't necessarily have to call 911 and run off to the emergency room, but you should get a hold of your doctor. And if you can't get a hold of your doctor then I would go to the emergency room or an urgent care even if your child is doing well because you do want them examined to determine the cause of the fever.

So you definitely want to seek help, but if they haven't stopped breathing, they're not turning blue, it's lasted less than 15 minutes and they seemed to be doing OK after that, you don't necessarily have to call the emergency squad, but you should call your doctor.

Now what will your doctor do? Well, for simple febrile seizures really little workup is needed, especially if the fever has a known source. So if your doctor sees your child after they've had a brief febrile seizure and they have a runny nose and a bad looking ear and a reason for the fever and otherwise their exam looks pretty good then that's something that your doctor may feel comfortable with just treating the source of the infection.

Blood count may be helpful in determining if it's a bacterial process or a viral process, especially if you don't see a known source. And electrolytes may also be useful to make sure that your child doesn't have a too high or too low of a sodium because that can also cause a seizure, although those seizures usually last longer than 15 minutes. They usually last until you correct the salt imbalance.

But if your child has a history of diarrhea and has lost a lot of fluid or you're worried about dehydration then your doctor may check electrolytes. Again, I'm only mentioning these things so that you have a general understanding of the sort of test that we do, not because you're going to be telling your doctor, hey, do you need to order electrolytes and don't you think you ought to get a blood count? It's really just so you have some idea when your doctor says, now we're going to check some blood. But again, if it's a simple febrile seizure with a known source blood work may not be needed.

12:31

What about an EEG? That's where they hook the electrodes up to a kid's head and look at the brain waves to see if they have epilepsy. EEG is generally not indicated for simple febrile seizures. Now if your child is six months to twelve months of age, so it's a young baby who's had her first febrile seizure, some doctors would recommend going ahead and doing a spinal tap to rule out meningitis. Again, this is something you just need to talk to your doctor about, especially if you're baby is irritable or has been not eating very well or just doesn't seem to be his self or her self then that's something that in those kids you're a little bit of a higher risk of having meningitis as the underlying cause of the fever and the seizure. So if kid's less than 12 months of age your doctor may think about doing a spinal tap.

Kids who are 12 to 18 months of age, the index's suspicion for a meningitis is going to certainly be less but it's still there. If you had a kid who is a year to a year and a half old and he had a febrile seizure, even if it's a simple febrile seizure but they've been irritable and not eating well and you can't find the source of the infection, a spinal tap may still not be a bad idea.

For kids who are over 18 months of age, generally a spinal tap is not needed for these kids because bacterial meningitis is a lot less common. But again, if they have a stiff neck and extreme irritability or they were inconsolable then you may think about doing that.

14:04

OK. The work up for a complex febrile seizure and a symptomatic febrile seizure is a little bit different because there's a focal pattern to the seizure or it's lasting so long. A lot of doctors will get a CT scan or an MRI of the brain to make sure that everything looks OK

Also they may do a spinal tap to look for meningitis depending on their age and other symptoms, especially if there's a focalness to the seizure or they're recurrent febrile seizures, an EEG to look for epilepsy at that point may also be helpful. And of course referral to a pediatric neurologist if they're having recurrent febrile seizures or complex febrile seizures is something else that your doctor may consider.

Now what about treatment? Well simple febrile seizures really don't need any treatment. However, prolonged complex febrile seizures may need anticonvulsant therapy, just meaning epileptic-type drugs to help stop future seizures from happening.

This is rare and really most primary care pediatricians aren't going to start kids on anti-seizure medicine. If your child's having recurrent febrile seizures or complex febrile seizures usually we get a pediatric neurologist involved and let them do the work up and figure out the treatment plan.

What about prevention? Well there's really no good unless they recur frequently and the neurologist is using meds. But remember those meds do have side effects and should not be used lightly. But you have to remember this, seizure usually happens with the first temperature spike and then once that seizure is over and the child's awake long enough, in terms of treatment you certainly could give them Tylenol or Motrin to help them feel better, especially if the fever is still present.

But it's unusual for the seizure to repeat after the initial spike because if it does then it becomes recurrent and it's a complex one and like we said most of the cases that you're going to see are just going to be simple febrile seizures.

So my point with all these is while you think Tylenol or Motrin may prevent it, keeping their fever down, it's really tough because a lot of times the febrile seizure happens with that first temperature spike and you're not giving them Tylenol or Motrin because you didn't even know they were sick.

A lot of folks think, oh, when their child is sick we have to give him Tylenol or Motrin to keep the fever down and keep him from having a seizure. But really once they have the fever the risk of having a febrile seizure is a lot less, so the Tylenol or Motrin probably is not really going to be all that helpful.

But certainly, taking care of the fever is going to make your kids feel a lot better when they have the seizure. But again, talk to your doctor and if your child has a history of recurrent febrile seizures, certainly starting Tylenol or Motrin at the first sign of illness would be helpful.

The good news with all of these is that in the end the overwhelming majority of febrile seizures are not harmful even when they recur and kids usually outgrow the tendency to have febrile seizures after about age five. Remember the fever is not a result of damage to the brain caused by the fever, it's simply a way that some brains react to a rapid rise in temperature.

And finally, if your child has a seizure of any type, whether it's with the fever or not, be sure to let your doctor know right away.

[Music]

17:39

OK. In our toddler segment this week, we're going to talk about spreading colds and this is a listener mail we have from Deborah. She says, "My daughter is just turning one. We were fortunate and daddy stayed home with her the first year. Now she is going to a babysitter's house. Again, we are fortunate and that our babysitter watches two other children, ages three and four, so it's a very much a family environment. She is yet to have anything more than a passing runny nose even though she has four older siblings, nine, eleven, thirteen and fifteen, who are bringing home germs. Our older children went to a babysitter at six weeks old and had infections and colds from the very beginning. I've read that you can only get a virus once so children who are not exposed to germs early on are eventually going to be infected when they're older, so instead of spreading out the illnesses overtime she'll just get them all at once. So I wonder, should I be leery of the coming winter or is it possible that she just has a high immune system?"

Well thanks for your question, Deborah. I would definitely be leery. Keep in mind the immune system's really have to be built, we either have to become infected one or have an immunization really to start making antibodies and then when we see viruses or bacteria the next time our bodies can fight off the illness with these antibodies that your body made.

Now your daughter's health last winter was probably a combination of minimal exposure to viruses and the fact that at least up until about age six months or so the antibodies that mom builds up over the course of her life have crossed the placenta into the baby's body and provides protection during those first six months or so. But now that your baby is a little older for this coming winter those antibodies are pretty much gone and it sounds like she'll have more exposure to viruses this year at the babysitter's so watch out. The colds probably will be coming.

But ask your doctor about a flu vaccine and be sure to get our other routine immunizations as well. But you do make a good point. You do have to get these illnesses at some point and the kids who are at daycare and get a lot of viruses and colds and such at a really young age, when they go to kindergarten a lot of times they have seen a lot of these viruses and their immune system is ready to fight them off. Whereas, the kids who aren't exposed and seem to be pretty healthy the first few years of their life, when they go to kindergarten or to preschool they will be sick more often because it's just the way the immune system works, you have to be exposed to these things and get the illness so that you can fight them off the next time.

20:15

Now let's take a look at just how easily these viruses that cause colds spread. The question, common cold is caused by rhinovirus and since there are many different strains of rhinovirus you can become infected with that many times because you can get each strain once and there's lots of them.

We know rhinovirus spreads easily but just how easily? For instance, if you rub your nose and then touch a doorknob or a light switch, how long does the virus hang out on the knob or the switch waiting for some unlucky victim to happen by?

Well they did a study. It was conducted by Dr. Owen Hendley, M.D., Professor of Pediatrics at the University of Virginia Health System, he looked at this question. And the researchers found 15 volunteers who were infected with rhinovirus and they asked each one to simply spend a night in a hotel room. Now the volunteers were asked to move around the room in the evening, go to sleep, get up and then hang around for two more hours the next morning. And at the conclusion of the allotted time, each volunteer showed the researchers several places in the room where they had touched, such as doorknobs and light switches and water faucets.

Now altogether 150 sites were identified and tested for the presence of rhinovirus. And of the 150 sites, 52 were positive for the virus, which is 35% of the objects they touched. And they weren't told to rub their nose. They just basically lived in the room normally. So we know that 35% of the things that they happened to touch did have evidence of the virus on them.

The researchers conducted a second phase of this experiment – they saved mucus samples (Lovely, right?) from each volunteer and several weeks later they put little drops of each one's mucus on surfaces in another hotel room and some of the samples were left to dry for an hour and others were left for 24 hours. And then each volunteer came back to the room, which had been contaminated by his/her own mucus and contaminated surfaces, such as light switches and telephones were contaminated with this virus, that's where it was allowed to dry.

And then the volunteers were asked to flip the switch or pick up the telephone handset so that they would come into contact with their own virus again. And then the volunteer's fingers were tested for the presence of rhinovirus. Now they did it with their own mucus because these volunteers had just had that strain of rhinovirus, their immune system had built antibodies against it so there was not the fear that they would actually get sick from being exposed to this rhinovirus again; where if they had used cross-samples the people could have picked the strain of rhinovirus that a different one of the volunteers had had.

23:01

So basically, what'd they find? Well objects with mucus that were left to dry for 24 hours, basically the virus survived being stored and then dried and transferred to the volunteer's fingers after they had dried for 24 hours, a third of the time a viable virus was found on the volunteer's finger. Now if the mucus was left to dry for only one hour they virus transferred successfully two-thirds of the time.

So let's look at how rhinovirus is transferred? Rhinovirus needs direct contact with mucus membranes in order to transfer from one person to another. This means that an infected person's mucus come into contact with another person's nose, mouth or eyes. So if a kid with a cold rubs or picks his nose and then touches a shopping cart and you come along 24 hours later, according to the results of the study, and touched the shopping part then you have a 33% chance of getting rhinovirus on your hand; and if you come along just an hour later rather than 24 hours the chance increases to 66%.

Again, in order to become infected with rhinovirus your finger with the virus on it now has to touch your nose or your mouth or your eyes. So the best way to keep yourself from getting so many colds is to keep your hands away from your face and wash your hands with soap and water or use antibacterial hand gel frequently during the cold season.

This study was widely spread around the news media outlets because it makes for good copy. You can hear the headlines now, right? Reuters used "Touch a Light Switch, Catch a Cold". But I do want to make a couple of points, first, the study was sponsored by a company who makes a disinfectant spray. Now I'm not saying they fudged the data, I just think you should know who paid for it.

Second, they only took 15 volunteers with the study. So it is a small number, but the results don't really surprise me and I honestly think if a much larger sample had been taken the results probably would have been the same just knowing the biomechanics of how cold viruses transfer.

There is one problem I have with all these, the study tells us that once you put a virus on an object that stays there and when it's left to dry for 24 hours have the same degree of infective potential and that's really not addressed here. Also the rooms were not cleaned by housekeeping between contamination and pick-up, so that doesn't mean that you're at risk for picking up the previous occupant's germs in a properly cleaned hotel room. So that was not the purpose of this study at all.

And a final thought, it's an interesting study and it would definitely get some press. And regardless of the technique or the outcome, I think it's a good way to keep your hands away from your face and wash them often.

[Music]

26:05

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