YOUR CHILD’S HEALTH CARE/DISORDERS OF THE BRAIN AND SPINAL CORD: CONVULSIONS CLINICAL FEATURES AND INVESTIGATIONS
Clinical features
There are a number of different types of convulsions, but they are usually characterised by the sudden onset of a stiffening of the body, followed by jerking movements, after which the child usually sleeps deeply for an hour or so. Most convulsions do not last longer than several minutes. Convulsions can be partial, affecting only one part of the body, or general, involving the whole body.
Some convulsions (petit mat) do not involve jerking body movements, but simply appear as an ‘absence’ from activities. The child stares for a few seconds, and then continues with what he was doing as if nothing has happened. Epilepsy is the term given to the condition where the child has more than one seizure, and there is an abnormal EEG and Epilepsy.
The characteristics of a febrile convulsion are similar to those of a general convulsion. The episode is usually brief, lasting less than 5 minutes, and the child makes a complete recovery afterwards, although he may be a little drowsy for an hour or so. He will also have symptoms of the condition that caused the fever, such as a runny nose or earache or cough. Occasionally the febrile seizure will be associated with a more serious condition such as meningitis so it is important to see a doctor so that this diagnosis can be excluded.
Investigations
If your child has a convulsion which is not due to fever, your doctor will suggest that an EEG be performed, and occasionally a CT scan of the brain.
Investigations are rarely indicated for febrile seizures. Sometimes blood or urine tests, or a chest X-ray, may be performed to find the condition which caused the fever. An EEG is performed if there are repeated febrile convulsions but it is usually not indicated after a single episode.
*410\90\8*
YOUR CHILD’S HEALTH CARE/DISORDERS OF THE BRAIN AND SPINAL CORD: COMA
A child who is in a coma is unconscious; that is, he is unaware of his surroundings, and cannot be woken. There are various degrees of coma, from a light coma in which the child responds to being touched, to a deep coma in which there is no response to stimuli, and in which the child may even require artificial ventilation.
Cause
There are numerous possible causes for coma in children, including drug overdose, alcohol poisoning, meningitis or encephalitis, and head injury. An extremely low blood sugar in diabetics can also lead to unconsciousness.
Investigations
Blood and urine tests may be performed, in addition to X-rays and a CT scan, to determine the cause of the coma.
All children in a coma are admitted to hospital for assessment and treatment. The type of treatment depends on the degree and cause of the coma, but includes intravenous infusion and around-the-clock nursing care and life support facilities.
cause. It the coma is irreversible the outlook is poor. However, if the cause can be treated and the child shows improvement, this is a positive sign for recovery, which may be partial or complete. The exact treatment and outlook varies with the cause, severity and duration of the coma.
Prevention
Drugs and poisons should be kept away from children. Head injuries causing coma can be minimised by insisting on helmets for bike-riding and horse-riding.
Regular monitoring and good control in a diabetic child can prevent dramatic fluctuations in blood sugar levels, thus minimising any likelihood of diabetic coma.
*408\90\8*
YOUR CHILD’S HEALTH CARE/DISORDERS OF THE BRAIN AND SPINAL CORD: CONVULSIONS TREATMENT AND PREVENTION
The long-term treatment of general convulsions will depend on their cause and severity.
A febrile convulsion usually lasts only a few minutes, and almost always stops by itself before any treatment is given. If the seizure is prolonged, the child is taken to the doctor or hospital where medication is given (intravenously or rectally) to stop the seizure. It is not usually necessary to hospitalise a child following a febrile seizure, unless there is concern about the condition which caused the fever (such as pneumonia or meningitis). Generally, the child is assessed, the underlying condition treated, and the child is sent home.
When to see your doctor
• if it is your child’s first convulsion;
• if your child has several convulsions;
• if convulsions occur often.
Prevention
To prevent recurrences of febrile convulsions, you should try to lower your child’s fever (for example, using paracetamol as soon as you become aware of the problem. However, sometimes the seizure will be the first indication of a fever. There is no point at all in giving your child anticonvulsant medication whenever he develops a fever, because it takes several days to build up sufficiently high blood levels of the drug.
If the child has recurrent febrile seizures, your doctor may consider prescribing anticonvulsant medications to be taken on a continual basis for several years to prevent the seizures from occurring. However, this should only be instituted and managed by a paediatrician or paediatric neurologist.
*409\90\8*
YOUR CHILD’S HEALTH CARE/DISORDERS OF THE BRAIN AND SPINAL CORD: CONVULSIONS
Convulsions are also known as fits, epileptic attacks or seizures. They are states of altered consciousness which can vary in severity. About 1 in 100 people have a seizure of some kind during their lifetime, and about half of these occur during childhood.
Febrile convulsions (seizures which occur due to fever) are relatively common, occurring in approximately 4% of children between the ages of 6 months and 5 years. The majority of these children will only ever have one fit; most will occur while the child is less than 3 years old. Those children who have their first febrile convulsion before the age of 1 year have a higher risk of having recurrent febrile convulsions. This type of convulsion tends to run in families, and to affect boys more often than girls. Even though it can be very frightening to see your child having a febrile convulsion, remember that children do not die from this, nor do they suffer long-term consequences or brain damage.
Convulsions are due to sudden, abnormal electrical activity in the brain. There are many causes for convulsions which do not occur in relation to fever; the most common is scarring of brain tissue which may occur after head injury. Convulsions in some children may be triggered off by flashing lights, such as a strobe light, or looking at patterns on a screen. There is usually a family tendency towards having convulsions.
Febrile convulsions occur as a direct result of a high fever which may accompany an infection. For reasons that are unclear, the rapid rise in temperature causes an abnormal electrical discharge in the brain, which results in the seizure.
*411\90\8*
STRESSES AND CHANGES IN A CHILD’S LIFE: TEMPERAMENT
All parents will know that no two children are alike in terms of their temperament and personality. Often parents will say that the differences are noticeable from birth; in other children they become more noticeable over time. The term temperament is now used to describe these individual differences. Temperament is believed to be intrinsic but also to be modified by the environment.
A child’s temperament is like a filter through which he experiences and interacts with the environment. It is the behavioural style of the child. Babies with a difficult temperament are more likely to be reported as having colic, sleep problems, and excessive crying, and as they grow older more likely to have temper tantrums and a slower school adjustment. Children with an easy temperament are less demanding of their parents, and generally easier to manage. They settle quickly into a predictable routine, are easily adaptable, and far more easy going. There are also those who have a slow-to-warm-up temperament. They may be somewhat difficult initially because they do not adapt easily to change, and take some time to get used to things.
It is not the child’s temperament alone which is important, but rather, the interaction of his temperament characteristics with the child-rearing style of his parents which determines whether there will be difficulties. A baby or child with a difficult temperament may make some parents anxious and insecure about their parenting. They may blame themselves for the fact that the child seems quite difficult to manage. Other parents may be able to be more accommodating of their child’s temperament. They will be more flexible in their parenting style, so that consequences of the child’s difficult temperament are minimised.
Similarly a child who has a slow-to-warm-up temperament also needs the understanding of parents. He will tend to hold back from new and unfamiliar situations, and react by crying or hanging onto the parents. Sensitive parents and teachers will be aware of this, and not push the child until he is ready.
As parents, you will achieve the best results by modifying your child-rearing style to take into account your child’s individual temperament characteristics. It follows then that there is no single way to approach children, whether it be feeding, toilet training, discipline, or any other area of functioning. Each child must be treated as an individual.
*135\90\8*
DEFINITIONS OF SOME EXPRESSIONS YOUR DOCTOR MAY USE – POSSIBLE SIDE EFFECTS OF PAINKILLERS (DOSE)
If the dose you start with does not relieve your pain completely, you should gradually increase it either until it does or until you feel that the cost of the better pain relief outweighs the benefit. Possible side effects of painkillers include nausea, constipation, heavy sweating, drowsiness, lightheadedness, difficulty in concentrating, hallucinations, confusion and dizziness. Except for constipation, all of these are worst just after starting a new painkiller or increasing your dose. They tend to clear up by themselves, so it is usually worth persevering for a few days before deciding that a particular painkiller doesn’t suit you.
If, even then, you cannot find a dose that relieves your pain without unpleasant side effects, you should stop taking it altogether and change to a different painkiller. The alternative would be to add a second painkiller while continuing to take unsatisfactory doses of the first. If you do this, you are likely to finish up With much more troublesome side effects for the same degree of pain relief. It is better to find the single painkiller that suits you best and take effective doses of that.
*173/40/1*
WARTS – DESCRIPTION
Warts are one of those common conditions we all know about but few understand.
Over the centuries many fancy stories were believed about the cause and also the treatment of this common and obvious blemish.
Some people even believe warts are caused by handling frogs and toads.
There are many variations of warts but it is now believed they all are caused by the same thing but vary because of different environmental factors surrounding their growth.
Warts are caused by a virus and are infectious.
The common wart (verruca vulgaris) is a dry, rough, raised and usually irregular lump on the skin.
It may be single, or more commonly multiple.
These warts are particularly common on the hands and around the knees of children but no age is exempt.
The warts may last for years or only for months. They come and they may go.
All forms of different treatments have been used and success claimed for them all.
Some people apply urine, saliva or thistle juice to warts and claim these and many other means are effective ways of dealing with them.
*616/71/1*
FEET – BUNION
Bunions are thought to develop because we squeeze our feet into shoes which are too narrow for the forefoot. Coupled with this may be an inherited tendency for the first metatarsal or long bone of the foot to splay medially or inwards.
The first deformity is a hallux valgus. The joint of the great toe (hallux) is forced laterally, or outward, so that the toe turns inward, crowding the other toes.
An exostosis, or bony projection, develops on the medial or inner side of the head of the metatarsal, where it forms the big toe joint.
The bunion is a small bursa or fluid sac which forms on the medial side of the joint over the projecting bone. It may become inflamed or infected. The second toe gets crowded out and may over or under-ride the first toe.
A foot with all these deformities doesn’t look good but may not, at first, be painful. Doctors are reluctant to operate for cosmetic reasons only and usually wait until the person is inconvenienced by progressing pain.
*358/71/1*
CYSTITIS – DRINKING ANY FLUIDS
Even drinking large amounts of any fluid, usually water, will relieve the discomfort. But although the symptoms are eased, this does not mean that the condition is cured. It may, and often does, recur.
That is why it is necessary to go to a doctor if you have cystitis and for the doctor to treat it seriously.
The proper treatment involves taking a sample of urine under sterile conditions and looking at it under the microscope. A culture is set up, and any germs present are grown and matched against a number of antibiotics.
It may take three days for the results and a woman should not be expected to suffer discomfort for this length of time.
*108/71/1*
HOW MAJOR IMPROVEMENTS IN CHEMOTHERAPY HAVE COME ABOUT – MID-1970S
In the mid-1970s, the same degree of improvement occurred in the treatment of testicular cancer. This time it was a new drug rather than a new technique (the use of high dose combinations) that was responsible for the breakthrough. A new drug called cis-platinum had been shown to be active against testicular cancer in Phase II studies. This drug, when combined with the two previously best drugs (vinblastine and bleomycin) produced complete remissions in most patients with cancer of the testes, many of whom were later shown to be cured altogether. Prior to that about one in three patients with extensive cancer of the testes experienced remissions which were only partial and temporary, cures were unusual. Again, special research techniques were not necessary to prove that the new treatment was much better than what had been used previously.
*139/40/1*