The weather has changed suddenly recently, and the temperature difference between morning and evening is large, which is the season of high incidence of respiratory diseases. Recently, our department has received many children with high fever convulsions, many of which are the first convulsions. Such children make parents anxious and panicked.

　　 In fact, pediatric high fever convulsions is a common emergency in pediatrics. It is not life-threatening and will not affect the intelligence of children. To tell parents about this disease today, I want to help parents to master some knowledge of this disease, know how to prevent an attack, or how to deal with it after ventilating, so as not to blindly panic. This is the purpose of this article.

　　 After a child with a high fever (mostly above 39 degrees), a sudden convulsion occurs, which we call hyperthermia convulsion. Manifested as loss of consciousness, eyes turned up, closed teeth, twitching of limbs. It is more common in infants and children from 6 months to 5 years old. Seizures usually occur when the fever is high, and the duration is relatively short, about 2 to 3 minutes. After the seizures stop, the child will also wake up. Under normal circumstances, only once during the illness.

　　What should the child do when there is convulsions:

　　What should parents do when convulsions

　　 1. Don’t hurry to pick up the child, the child should be placed quickly In the lateral position, this can avoid the risk of suffocation when the child vomits.

　　 2. Unfasten the child''s clothes quickly so that the child can breathe smoothly and dissipate heat.

　　 3. Do not give antipyretic medicine orally. Put a fever plug in the anus of the child, and wipe the child’s head, neck and limbs (without rubbing the front and back heart) with the warm towel to help cool down.

　　 4. When the child has stopped convulsions, immediately send the child to the hospital. If the ventilation has not stopped for more than 3 minutes, don’t wait and send the child to the hospital immediately.

　　Wrong practice by parents during convulsions

　　Parents often get very panicked and overwhelmed when child convulsions occur. This is unreasonable for some parents who pinch their children hard, because it often has no effect, and it will also break the young skin of the child.

　　Hospital checkup after convulsions

　　Children with convulsions, especially those with first convulsions, must be examined in detail, including head CT, EEG Figures, blood routines, complete sets of biochemistry, etc., can not distress the child, refuse to check.

　　After convulsions, don’t hide family history

　　The majority of children with high fever convulsions have family history, that is to say, the disease and heredity have great Relationship, many children have a history of shock when they were young. But many people deny that they have this medical history. The second is that I really don’t know, because the previous generation of the child’s parents concealed their condition. In fact, I think that from a certain point of view, a child with a family history of heat shock is better than a child without heat shock, because of the genetic tendency, the diagnosis is easier. But there is no genetic tendency, and suddenly the wind is likely to be other diseases. Therefore, after the child is shocked, the child''s parents must go home and ask their parents, whether they have a history of fever convulsions when they were children or other siblings.

　　High fever convulsions focuses on prevention

　　The incidence of high fever convulsions is about 2% to 4%. Among children with high fever convulsions, 1/3 have the second Convulsions, 1/2 of which had a third convulsion. About 1/10 had 3 or more relapses. The recurrence of high fever convulsions occurred within 3 years of the first seizure. Although convulsions are different from epilepsy, most children have a good prognosis, but each seizure attack will more or less affect the child''s physical and psychological, and it is a great psychological pressure on the child''s parents. It is critical to prevent or reduce the recurrence of febrile convulsions.

　　(1) Reducing the incidence of primary disease

　　High fever convulsions, almost all of which are caused by a sudden high fever after a child''s respiratory infection. Therefore, such a child, as far as possible to reduce colds, colds less, the chance of convulsions is less, this is the key. In the clinic, I have observed that many children with high fever convulsions are also allergic, with allergic rhinitis, urticaria and other diseases. Therefore, such children should pay attention to the treatment of allergic diseases at the same time, not just anti-inflammatory treatment. . After the allergy is corrected, the child''s "recurrent cold" situation can be reduced, and the heat shock is reduced. Therefore, children with convulsions of high fever, in addition to looking for a doctor in the neurology department, if they have allergies, they must see the doctor at the respiratory department to help correct the allergies.

　　(2) How to prevent medication

　　1, long-term continuous medication prevention

　　The long-term continuous drug prevention of the disease has the following evolution: from the 1960s to the 1980s, many medical researchers advocated the use of long-term continuous drug prevention, the main drug was phenobarbital, and a few people used sodium valproate.Since the 1990s As the follow-up data proves that most children with this disease pass by benignly, the proportion of seizures or neurodevelopmental abnormalities is extremely low; on the contrary, the long-term application of phenobarbital prevention can lead to abnormal mental development and behavior of some children and sleepiness , Sleep disturbances, aggressive behavior, hyperactivity or inattention, and other adverse reactions. Long-term use of sodium valproate, in addition to causing abnormal behavior in children, may also cause severe liver damage. 2000 Nissl Pediatrics The 16th edition no longer recommends the use of phenobarbital for long-term preventive medicine, and proposes the use of diazepam for short-term administration. Of course, it is not that long-term medicine has been eliminated, and experts in different countries have proposed some indications for use.

　　If any of the following three items appear, advocate long-term medication

　　(1) there is a nervous system abnormality before fever

　　(2), the duration of the attack is 15-20 minutes long The author

　　(3), who had partial seizures or accompanied by generalization.

　　(4), those with parents or siblings who had febrile convulsions or epilepsy.

　　(5), age of onset <1 year old or>6 years old.

　　(6), those who relapse 2 to 3 times within 24 hours

　　(7) , Body temperature is less than 37.5 degrees before fever.

　　(8), simple febrile seizures repeated 4 to 5 times a year,

　　(9), EEG is specific Epilepsy wave distributor.

　　A professor in China proposed in 1999

　　(1) Those who have had 2 or more episodes of hypothermia;

(2), each episode has a history of 15-20 minutes of long-term attacks or invalid intermittent administration;

　　2001 Japanese experts proposed

　　(1): already before fever Abnormal central nervous system

　　(2) Low fever can cause seizures and repeated seizures

　　(3), complex partial seizures and long-term authors

　　( 4) Failure to prevent intermittent administration or difficulty in implementation

　　(5), those with genes related to febrile convulsions have been identified.

　　2. Prevention of intermittent medication

　　 At present, the specific usage of domestic short-term stabilization has basically reached a consensus: the usage is rectal administration, the dose is 0.5 mg/kg body weight each time, 8 hours after the first use After repeated use for the second time, you can receive satisfactory results. If the child still has fever after 24 hours (>38 degrees). It can be administered for the third time. The introduction of Nie’s pediatrics can also be stable Tablets are taken orally, the dose is 0.3/kg each time, and it is used every 8 hours apart. The total amount is 1mg/kg. d. Generally, it can be used for 2 to 3 days with the heat course. In this method, the side effects include drowsiness, irritability or a total of Ataxia and so on.

　　 In short, the study of the disease needs to be prospectively studied in order to make an objective evaluation. It must also be noted that for all children with high fever convulsions, oral At the same time, diazepam must use antipyretics (such as ibuprofen and acetaminophen) to quickly cool down, and actively choose antibiotics to control the primary disease.

　　Prognosis of high fever convulsions

　　 Research shows that it is basically certain that the majority of hyperthermia convulsions manifest as a benign self-limiting disease, in which the rate of conversion to epilepsy does not exceed 5%, but those with high-risk factors may be higher. The relatives of the children are most concerned about whether convulsions cause the children’s intelligence, behavior, learning ability, academic progress, etc. The preliminary conclusions are optimistic. Verity et al. conducted a prospective study of 14,676 children born in a week in April 1970 in the United Kingdom. Among them, 287 cases were simple febrile convulsions and 94 cases were complex febrile convulsions. Compared with the control group with no history of febrile convulsions, their intellectual development and academic progress were no different from those without disease. From 1984 to 1987 In a hospital, 106 children hospitalized for the first febrile seizure had a long-term follow-up of 5 to 8 years and found that 5.7% had converted to epilepsy, and 3 cases of mental retardation remained. One analysis found that one case had neurodevelopmental abnormalities before the onset. Although one case had only one episode, the parents were illiterate and lacked care and education for the child. In the other case, each episode exceeded 10 minutes, considering convulsiveness. Caused by brain injury.

　　The following situation may not be hot shock

　　If the following symptoms occur, you should be hospitalized to rule out encephalitis or epilepsy and other diseases.

　　1. If the heat is not high (below 38°C), convulsions occur.

　　 2. The duration of convulsions is longer, generally more than 5 minutes.

　　 3. Convulsion accompanied by vomiting.

　　 4. After the convulsion stops, the consciousness is still not fully recovered or the movement of the limbs is not the same as usual. Such as: stiff limbs, tremors and paralysis.

　　 5. Convulsions reappeared within 24 hours, and more than 2 times.

　　 6. Not a whole body twitch but a part of the body twitch.

　　Infants within 7 and 6 months and children over 6 years of age have seizures.

　　Doctors should be doctors who constantly teach science, and parents should be parents who keep learning. I hope parents read my article and know how to cooperate with doctors to care and treat children.