What to Expect the Toddler Years (205 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
FEBRILE CONVULSIONS
It’s estimated that 2 to 4 of every 100 young children experience convulsions (eyes roll back, the body stiffens, arms and legs twitch and jerk involuntarily) with a fever, usually at its onset. Though febrile convulsions are frightening for parents, doctors now believe that they are not harmful. Studies show that children who have experienced febrile convulsions show no later neurological or mental impairment, though they have a very slightly increased risk of future epilepsy (but the convulsions, it is suspected, are more likely to be a
result
of an inborn tendency toward the disorder than the cause of it). There appears to be a genetic factor in these convulsions (they run in families); but in most instances the major factor is probably immaturity of the young child’s brain. When the brain matures, febrile seizures cease.
Chance of Recurrence
If your toddler had febrile convulsions as an infant, he or she has a 30% to 40% greater chance of having an episode in the toddler years than does a child who’s never had such convulsions; but 7 or 8 out of 10 children who have one episode never have a second. Those most likely to have recurring seizures are children who have had seizures lasting longer than 15 minutes, whose convulsions came on shortly after the onset of fever, or whose fevers were not very high at the time of the seizure, and those in whom an underlying cause for the seizures exists.
Ongoing medical treatment for febrile seizures hasn’t been found to affect the chances of recurrence. Nor does treatment of a fever seem to reduce the incidence of seizures during an illness in predisposed children, probably because these convulsions almost always occur at the outset of an illness, just as the fever is rising and before treatment can be given.
Handling Febrile Convulsions
Should your toddler have a febrile convulsion, keep calm (remember, such convulsions are not dangerous) and take the following steps. Check the clock, so that you can time the duration of the seizure. Then hold your child in your arms or place on a bed or another soft surface, lying on one side, with his or her head lower than the rest of the body, if possible.
Don’t
try to restrain your child in any way. Loosen any tight clothing.
Don’t
try to give food or drink or put anything into your child’s mouth; remove anything, like a pacifier or food, that might be in it. (To remove a bit of food or an object from your toddler’s mouth, use a sweep of one finger, rather than a two-finger pincer grasp, which might force the food further into his or her mouth.) A child may briefly lose consciousness during a seizure, but will usually revive quickly without help. The seizure will probably last only a minute or two.
If your child wants to sleep when the febrile seizure has ended, prop him or her in a side-sleeping position with blankets or a pillow. Then call the doctor (unless this is a repeat and the doctor has told you it isn’t necessary to call). If you don’t reach the doctor immediately, you can give a sponge bath and acetaminophen (in suppository form if your toddler doesn’t seem awake enough to swallow) to try to lower the temperature while you’re waiting. But don’t put your child in the tub to try to reduce the fever; should another seizure occur, there would be a risk of your child inhaling the bath water.
Important:
If your child isn’t breathing normally after the seizure or if the seizure lasts 5 minutes or more, get immediate emergency help by dialing 911 or your local emergency number. A trip to the emergency room will probably be necessary to determine the cause of this kind of complex seizure.
REATING A FEVER
An estimated 80% to 90% of all fevers in young children are related to self-limiting viral infections (the kind that get better without treatment). Most experts today do not recommend treating such fever in toddlers unless it is at least 102°F (38.9°C), and some suggest waiting until temperatures reach 104°F (40°C) before reaching for the dreaded medicine dropper. They may, however, recommend the use of acetaminophen even with lower temperatures to relieve aches and pains, improve sleep, generally make a toddler more comfortable, and sometimes, to assuage a nervous parent. On the other hand, illnesses caused by bacteria must always be treated with antibiotics, which lower temperatures indirectly by wiping out the infection. Depending on the illness, the antibiotic being given, the child’s level of comfort, and how high the fever is, antibiotics and fever-reducers may or may not be prescribed together.
Unlike most other infection-related fevers, fever associated with shock from a generalized bacterial invasion of the body, as in septicemia (blood poisoning), requires immediate medical treatment to lower the body temperature. So does fever from heat-related illness (see page 673).
If your child has a fever, take these measures as needed, unless the doctor has recommended a different course of action.
Keep your toddler cool.
Despite what Grandma may say, keeping a feverish child warm with blankets, heavy clothing, or an overheated room is not a safe practice; these measures can actually lead to heat illness by raising body temperature to dangerous levels. (The exception:
The child who has chills can be wrapped in a blanket until the shaking subsides.) Dress your feverish child lightly to allow body heat to escape (no more than diaper or underpants may be needed in hot weather), use only a sheet and/or a light blanket as a covering, and maintain room temperature at 68°F to 70°F (20°C to 21.1°C). When necessary, use an air conditioner or fan, if you have one, to maintain this temperature (but keep your toddler out of the path of the air flow or drafts from an open window).
Up the fluid intake.
Because fever increases water loss through the skin, it’s important to be sure a feverish toddler gets an adequate intake of fluids, from diluted juices; juicy fruits, such as citrus and melons; water; clear soups; healthful gelatin desserts; and ice pops made from fruit juice. Encourage but don’t force your child to take frequent sips of favorite beverages. If your child refuses to take any fluids for several hours, inform the doctor.
Down the fever—with medication.
But only if necessary. Remember, in most cases, fever plays an important role in fighting infection. The doctor may recommend acetaminophen (or sometimes, ibuprofen; see page 597) if your child has a fever of 103°F (39.4°C) or higher (taken rectally); seems very uncomfortable or in pain, or is unable to sleep. Be careful to adhere to recommended doses (see the next page).
Down the fever—with sponging.
But only under certain circumstances. Once a routine treatment for fever, sponging (which makes some children
more
uncomfortable) is now recommended only when a child has had an adverse reaction to fever-reducing medication or
when such medication isn’t working (the temperature isn’t down an hour after medication is given). It may also be recommended, in combination with a fever-reducing medication, such as acetaminophen, when a child has a fever of 104°F (40°C) or higher. Sponging (medication is
not
recommended) is the treatment of choice for heat illness (see page 673).
While cold water is used for sponging with heat illness, only
tepid
or
lukewarm
water (at normal body temperature, neither warm nor cool to the touch) should be used for sponging to bring down illness-induced fevers. Using cool or cold water, or alcohol (once a popular fever-reducing rub) with an illness-induced fever can raise, rather than lower, body temperature by inducing shivering, which provokes the body to turn up the heat instead of turning it down. Alcohol presents an additional risk: The fumes can be harmful if inhaled. Hot water sponging will also raise body temperature and could, like overdressing a feverish child, lead to heatstroke.
If your toddler enjoys being in a bath, you can sponge him or her in the tub. (But be sure that you don’t put a child who’s recently had a febrile convulsion into the tub.) Alternatively, you can sponge your fevered toddler on a towel-covered, waterproof sheet, pad, or plastic tablecloth. Whether you sponge in the tub or out, the room should be comfortably warm and draft free. If you are sponging in combination with a medication, give the medication half an hour before beginning. Have three washcloths and a tub or basin of tepid water ready before undressing your toddler. If you’re sponging out of the tub, cover your child
with a light towel. (Do not, however, cover your feverish toddler with a wet towel or wet sheet, since this could prevent the necessary escape of heat through the skin.) Wring out one wash-cloth so it won’t drip, fold it, and place it on your child’s forehead; remoisten if it begins to dry out during the sponging. Wet and lightly wring out another cloth and begin gently rubbing your child’s skin, one area at a time. Concentrate on the neck, face, stomach, inside of the elbows and knees, but also include the area under the arms and around the groin. The blood brought to the surface by rubbing will be cooled as the tepid water evaporates on the skin. When the rubbing cloth begins to dry out, put it back to soak and switch to the third cloth. Continue rubbing and sponging your toddler, alternating cloths as needed, for at least 20 minutes to half an hour (it takes this long to lower body temperature). If at any time the water in the basin cools to below body temperature, add enough warm water to raise the temperature again. If the bath causes shivering, warm up the water a bit, or if medication was given, wait 20 minutes longer for it to take effect.
DOSAGES FOR ACETAMINOPHEN AND IBUPROFEN
TYPICAL BODY TEMPERATURES*
Encourage a slowdown.
A really sick child will want to slow down, but many children with fevers want to keep romping. Allow moderate activity, but discourage strenuous activity, which could raise body temperature further.
Feed the fever.
The work of running a fever raises the body’s caloric requirements; those who are sick actually need more calories, not fewer.
Don’t overtreat.
Do not give an enema (an old fever remedy) or any medication (other than acetaminophen), except under a doctor’s directions. Do not give any medication (including acetaminophen) when you suspect heat illness.
Check with the doctor.
As necessary (see page 569); any fever that lingers for 8 days or more, in the absence of obvious illness, is considered a fever of undetermined source, or a fever without a source, and requires medical evaluation.
ARING FOR A SICK TODDLER
A
T HOME
How much rest?
Anyone who’s ever tried to inflict bed rest on a toddler who’s simultaneously running a fever and running circles around a worried parent knows how difficult it can be to keep a sick toddler down. But the good news is, it isn’t necessary to keep a sick toddler down—unless he or she seems to need the rest. There’s no evidence that bed rest affects a mild illness one way or the other. And you can almost invariably trust your child to pick up on and comply with his or her body signals. A very sick toddler will readily relinquish playful pursuits in favor of needed rest and relaxation, while one who is only mildly ill will be reluctant to slow down (just as the child on the road to recovery will be eager to pick up the pace). So unless restrictions on activity are “doctor’s orders,” there’s no need to impose restrictions of your own. Keep the home atmosphere as tranquil as possible, however; chaos isn’t good for a sick person of any age. And try to discourage vigorous activity when your child has a fever—the activity could raise body temperature even more.
How much time at home?
Follow the doctor’s advice about when to start venturing outside again with your toddler, and when to schedule a return to day care, preschool, or play group. In general, it’s recommended that a child who’s been running a fever of 101°F (38.3°C) or greater should stay home until the temperature has stayed below 100.2°F (37.9°C) for 24 hours. A child who has some residual symptoms (such as a cough after a cold) can resume normal activities once the fever’s gone, though a child who seems “wiped out” probably could benefit from a little extra time at home, if at all possible.