What to do if a child has convulsions

Convulsions, commonly known as \”convulsions\”, are a common critical illness in newborn babies, especially premature babies. Its onset is sudden, its changes are rapid, and its symptoms are dangerous. It is listed as one of the four major syndromes in pediatrics in traditional Chinese medicine. It usually occurs in children aged 1-5 years old. The younger the age, the higher the incidence rate. Most are a sign of critical illness. Once a newborn baby is found to have convulsions, he should be sent to the hospital immediately for further examination and treatment. Causes of infantile convulsions Causes of infantile convulsions can usually be divided into two categories: infectious and non-infectious. In terms of infection: there are infections of the central nervous system and infections outside the central nervous system. Infections belonging to the central nervous system include various encephalitis and meningitis; infections outside the central nervous system include sepsis, toxic bacillary dysentery, pneumonia, etc. There is also a type of convulsion caused by high fever, called febrile convulsion. For example, children under 3 years old who suffer from respiratory infections and other diseases may also have convulsions in the early stages of high fever. Causes of organic diseases: In addition to convulsions caused by infection, there are also causes such as metabolism, toxicity, and organ diseases. Metabolic causes include hypocalcemia, hypoglycemia, vitamin B1 or vitamin B6 deficiency, hyponatremia, hypomagnesemia, etc. Toxic causes include excessive use of central nervous system stimulants, such as aminophylline. , antihistamine drugs, etc., poisoning by pesticides 1605, 1059, dichlorvos, trichlorfon, dimethoate, etc. can also cause convulsions. There are brain diseases such as brain trauma, cerebral palsy, brain hypoplasia, and also caused by heart, liver, kidney and other diseases. There are many reasons for convulsions in infants; common ones are: 1. Febrile convulsions. When the body temperature of infants rises above 39°C, especially when it is close to 40°C, they are very prone to convulsions due to immature brain development. 2. Hypocalcic convulsions. When a baby\’s blood calcium is too low, the nerve excitability increases and tetany is more likely to occur. In severe cases, it can also be accompanied by laryngospasm, which is very dangerous. At this time, intravenous calcium should be administered as soon as possible. Central nervous system infections, such as purulent meningitis, sepsis, etc. The child has a fever and other neurological symptoms. Postpartum trauma, infants with intracranial injury or hypoxic-ischemic encephalopathy during delivery may develop convulsions. Inborn errors of metabolism or congenital malformations are less common. Once a convulsion occurs at home, parents must not panic, do not slap or shake the child forcefully, and do not hold the child in their arms. Quickly lay the child flat on the bed, without a pillow, in a side-lying position so that oral secretions can flow out smoothly without choking the trachea. If the twitching is frequent, you can use your thumbnail to stimulate the baby\’s Renzhong point (the center of the nasolabial fold). After the situation stabilized, he was sent to the hospital for treatment. Symptoms of infant convulsions: 1. During convulsions, infants turn their heads to one side, neck to the back, eyes straight or slanted to one side, eyeballs moving upward, foaming at the mouth, limbs straight or shaking, and hands making fists. There may be fecal and urinary incontinence (that is, peeing your pants). 2. Feeling confused when convulsing, not breathing, and having a blue face. The convulsion can last for a few seconds or minutes before relieving itself and stopping the convulsions. If the convulsions last for more than half an hour and still cannot stop, this is medically called status convulsant. After the convulsions stop, the baby often falls asleep. Babies may have quarrels andTwitching of the corners of the eyes, apnea or irregular breathing. 3. The convulsions are mild and irregular and can easily be ignored. It is rare for convulsions to occur only once. Often the convulsions stop once and then occur repeatedly or again after a period of time. It is worth reminding that babies may have local small muscle twitches after falling asleep. Sometimes when the baby is about to wake up but is not yet fully awake, the hands and feet move wildly, or when the baby is asleep and is stimulated by sound or light, you can see brief and slight twitching. This is a normal phenomenon and should not be mistaken for convulsions. Treatment of infantile convulsions The treatment of neonatal convulsions is first to target the primary lesion and secondly to the convulsions. Unless it is a convulsion manifesting as apnea, anticonvulsants are usually not required during convulsions because they are generally self-limiting and rarely endanger the vital functions of newborns. If blood sugar is low, 10% glucose 2ml/kg should be given intravenously; if there is hypocalcemia, 10% calcium gluconate 2ml/kg (containing 18mg/kg) should be given (note: the rate of calcium gluconate should not exceed 50mg/min, Continuous cardiac monitoring at the same time) should avoid extravasation because it will cause skin corrosion. If there is hypomagnesemia, give 50% magnesium sulfate 0.2ml/kg intramuscularly. Use antibiotics to treat neonatal seizure infections. Treatment of the convulsion itself should be directed immediately after examination to determine the cause of neonatal convulsions. Choose phenobarbital and give a loading dose of 20 mg/kg intravenously. If the convulsion does not stop, 5 mg/kg can be given every 15 minutes until the convulsion stops, or the maximum dose of 40 mg/kg has been given and maintenance treatment can be started after 12 hours. The dose starts from 3-4 mg/(kg.d) and can be increased to 5 mg/(kg.d) based on clinical response and serum drug concentration. Phenobarbital must be administered intravenously, especially when convulsions are recurrent or prolonged. When the convulsions are controlled, phenobarbital can be administered orally. The effective therapeutic concentration of phenobarbital is 15-40 μg/ml (65-170 μmol). /L). If a second drug is needed, phenytoin can be used, with a loading dose of 20 mg/kg. In neonates, it is only effective through intravenous injection. It should be divided into 2 times (10 mg/kg) and injected slowly intravenously to prevent hypotension and cardiac rhythm disorders. Signs of neonatal phenytoin poisoning are difficult to detect and sustained high concentrations would be harmful. If the blood concentration can be measured, the risk will be reduced. The maintenance dose starts from 5mg/(kg.d) and is used in 2 times. The effective therapeutic blood concentration of phenytoin is 10-20μg/ ml(40-80μmol/L). Infants receiving antineonatal convulsants should be closely monitored. Overdose may cause respiratory depression, which may be more dangerous than the convulsions themselves. Anticonvulsant treatment must be continued until the convulsions are controlled and the risk of subsequent convulsions is reduced. Types of infantile convulsions 1. Microseizures: more common than other types, with mainly head and face manifestations, no limb tonicity or clonus, slight movement during the seizure, weak and localized convulsions, and can manifest as apnea, eyeball deviation, eyelid convulsions, Twitching, lip trembling, sucking and swallowing, mydriasis, sometimes accompanied by abnormal crying and laughing, or only autonomic symptoms, sometimesIt is accompanied by body movements such as cycling, stepping, and swimming. 2. Multifocal clonic convulsions: This kind of convulsions are migrating and have no fixed sequence. During the seizure, the clonic movements quickly move from one limb to another, or from one side to another. Lateral, prolonged focal clonic movements are limited to one limb or to the upper and lower limbs on the same side before starting elsewhere. 3. Focal clonic convulsion: This kind of convulsion starts from one limb or one side of the face, and can extend to other parts of the same side. Generally, there is no unconsciousness. During the seizure, localization on one side can be found near the central sulcus. High-amplitude sharp waves that may extend to adjacent areas in the ipsilateral hemisphere or to the contralateral side. Mild localized attacks sometimes cannot be identified, such as slight tremor or rigidity of one limb or fingers (toes), strange movements of the limbs, such as pendulum-clock-like movements of the upper limbs, pedal-like movements of both lower limbs, etc. 4. Catalonic convulsions: manifested as stretching and stiffness of the whole body, accompanied by apnea, upward squinting of the eyes, and a few cases of generalized tonic seizures. This type is more common in premature infants and often indicates organic brain damage. 5. Myoclonic convulsion: This type is clinically rare and often indicates diffuse brain damage. It is characterized by simultaneous rapid pulling movements of the upper limbs and/or lower limbs. There are often no special abnormalities in the electroencephalogram. Prevention of infantile convulsions Infantile convulsions have a certain impact on children\’s health. Active prevention is an effective measure to protect children\’s health. The main prevention methods are: 1. Strengthen nursing care and physical exercise for children. Open windows frequently for ventilation indoors, and allow children to move outdoors more so that the body can adapt to the environment and reduce the occurrence of infectious diseases. 2. Pay attention to nutrition. In addition to milk-based diet, children should also add complementary foods in time, such as cod liver oil, calcium tablets, vitamin B1 and vitamin B6, and various minerals. Children should not be made hungry to avoid hypocalcemia and hypoglycemic convulsions. 3. Rational use of drugs: Use drugs appropriately and rationally to prevent children from accidentally taking toxic drugs. 4. Strengthen care to prevent children from hitting their heads and causing brain trauma, and do not hit children on the head with your hands at will. If a child has a convulsion, let the child lie on his side, untie his collar and wrap a tongue depressor with a handkerchief or put chopsticks between the upper and lower teeth to prevent him from biting his tongue; keep the child quiet and prohibit all unnecessary stimulation. . If a child with convulsions has a high fever, you can use cold water, well water or 30-50% alcohol to bathe, or use cold salt water enema, and use metamizole intranasal drops or intramuscular antipyretic injections. If the convulsions persist, you should be sent to the hospital for treatment immediately. Treatment of infantile convulsions The treatment of neonatal convulsions is first to target the primary lesion and secondly to the convulsions. Unless it is a convulsion manifesting as apnea, anticonvulsants are usually not used during convulsions because they are generally self-limiting and rarely endanger the vital functions of the newborn. If blood sugar is low, 10% glucose 2ml/kg should be given intravenously; if there is hypocalcemia, 10% calcium gluconate 2ml/kg (containing 18mg/kg) should be given (note: the speed of giving calcium gluconate should not exceed 50mg/min. Continuous cardiac monitoring at the same time) should avoid leakage outside the blood vessels because it will cause skin corrosion. If there is hypomagnesemia, give 50% magnesium sulfate 0.2ml/kg muscle.Note. Use antibiotics to treat neonatal seizure infections. Treatment of the convulsion itself should be directed immediately after examination to determine the cause of neonatal convulsions. Choose phenobarbital and give a loading dose of 20 mg/kg intravenously. If the convulsion does not stop, 5 mg/kg can be given every 15 minutes until the convulsion stops, or the maximum dose of 40 mg/kg has been given and maintenance treatment can be started after 12 hours. The dose starts from 3-4 mg/(kg.d) and can be increased to 5 mg/(kg.d) based on clinical response and serum drug concentration. Phenobarbital must be administered intravenously, especially when convulsions are recurrent or prolonged. When the convulsions are controlled, phenobarbital can be administered orally. The effective therapeutic concentration of phenobarbital is 15-40 μg/ml (65-170 μmol). /L) If a second drug is needed, phenytoin can be used. The loading dose is 20 mg/kg. In neonates, it is only effective through intravenous injection. It should be divided into 2 times (10 mg/kg) and injected slowly intravenously to prevent hypotension and cardiac rhythm disorders. Signs of neonatal phenytoin poisoning are difficult to detect and sustained high concentrations would be harmful. If the blood concentration can be measured, the risk will be reduced. The maintenance dose starts from 5mg/(kg.d) and is used in 2 times. The effective therapeutic blood concentration of phenytoin is 10-20μg/ ml(40-80μmol/L). Infants receiving antineonatal convulsants should be closely monitored. Overdose may cause respiratory depression, which may be more dangerous than the convulsions themselves. Anticonvulsant treatment must be continued until the convulsions are controlled and the risk of subsequent convulsions is reduced. Scientific parenting knowledge: Infant and young child home care encyclopedia video complete collection of infant convulsions care. No matter what the cause of the convulsions, the first thing to do is to control the convulsions with medication as soon as possible. Otherwise, if the convulsions last for a long time, they may cause fever or affect the heart and brain functions. Death by suffocation. And good care can prevent unexpected deaths in babies. 1. Place the child correctly. Place the baby with convulsions on the bed. Lying on his side can prevent vomitus from being inhaled into the trachea. Untie the collar and loosen the belt. Do not ask family members to move the baby around, keep it quiet, and have someone guard the baby by the bedside to prevent him from falling. 2. Prevent tongue bites. Trismus occurs during convulsions. To prevent tongue bites in infants, a cloth pad can be placed between the upper and lower teeth, or a tongue depressor can be wrapped with gauze. Don\’t pry hard when the teeth are clenched. 3. Keep the respiratory tract open. Children will not cough or swallow when convulsing, so they must lie on their side to allow phlegm or secretions from the mouth to flow out on their own. If there is too much secretion, it must be sucked out with a catheter to avoid blocking the trachea and causing suffocation. 4. Pay attention to breathing. Generally, regardless of whether the face is bruised or not, oxygen should be inhaled to protect the brain tissue and prevent hypoxic encephalopathy. 5. Find out the cause of the convulsions as soon as possible.