Event often traumatic for parents, convulsions in a young child challenge and make fear the worst.Fortunately, they do not all represent an absolute medical emergency.How to react ?Update with Dr. Jean-Louis Chabernaud, pediatrician-reanimator at Public Assistance-Hospitals in Paris.
What is a convulsion in a baby?
The scene is barely bearable for the parent who lives it: for several (long) minutes, you are powerless in the face of the uncontrolled movements of your young child.It is taken from convulsions and tremors, sometimes violent, and you do not know how to react.For Dr. Jean-Louis Chabernaud, pediatrician-resuscitator experienced in the public assistance-Hospitals of Paris, and author of the book Le Grand Book de Mon Child (Eyrolles), it is already necessary to determine what a convulsion is: "WeTrends today to call this no longer convulsion, but epileptic crisis, whether the subject is epileptic or not elsewhere.It is a clearer translation of what we see, of the major discharge which occurs in his brain.»»
An epileptic crisis could result in several symptoms.
For the specialist, it is important that the adult present observes the shape of the convulsion to detail it later: "Does the arms and legs move in the same way on both sides, is thereEye movements, the mouth that is twisted.These signs can be made by a disorderly activity of an area of the brain, "he explains."These are elements that will be requested in the office as well as in the emergency room, to determine the crisis and find the cause," he explains.Then first reflex as a parent: observe.
À lire aussiWhy does baby make convulsions?What causes this state?
The subject can be simple as complicated, sometimes very worrying.Determining the cause is therefore the whole issue for the emergency room, especially on a subject that is not epileptic.
When the convulsion occurs when the child has a fever, it is called feverish, or hyperthermal convulsive crisis.And fortunately it is the most frequent: "Genetically, 2 to 5 % of children between 6 months and 5 years old, in the world, will experience at least one feverish convulsion crisis", evokes the specialist (source 1).It is a form of convulsion which is not necessarily serious and which will disappear the age of 5 years.
This epileptic crisis can be caused during simple infections, rhinopharyngitis, otitis, cough ... and contrary to what one might think, it does not need a strong fever to happen: we seeConvulsions start even during moderate fevers (38 ° C)."It is a reaction of the brain in certain children in contact with certain viruses, which will request brain cells in an anarchic way, during the phase where there is fever," explains the pediatrician.
In this specific case, even if it is necessary to eliminate an infectious cause, the child completely recovers after the crisis and does not seem to be affected."It is still important to consult a pediatrician, the first time, assures the doctor, to eliminate another cause, and to understand, but they are children who are doing well.About 30 % of these children will experience a recurrence.Oral medication, midazolam, can then be administered to stop the convulsion.
We also know that an infectious cause such as meningitis, or herpetic encephalitis, can cause an epileptic crisis."Even if there is less risk today to contract this, babies being vaccinated early on several bacteria."These infectious causes also cause fever, but the child does not recover quickly as with a classic feverish crisis.
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Much more serious, convulsions can also arrive during a trauma, during a fall for example.“Sometimes a fall in the sofa is enough, or often the changing table to cause convulsions.If hematoma is formed in the child's brain, the convulsion can cause eye movements, and dissociated signs ”.The child does not recover in a few minutes.It is necessary to quickly call on 15 and emergency services.
Another cause that must be kept in mind: poisoning.The convulsion can occur after the absorption of drugs for example, or in the presence of carbon monoxide, which can arrive in households in winter, when heating is not up to standards.“It is children who know the effects first, because they are smaller and in an elongated position."In doubt, you have to call for help to find out if the whole family is poisoning themselves.
Children who know kidney problems, or a disease that deprives them of sodium, potassium and calcium can also experience episodes of convulsion.This is also the case for children who suffer from hypertension.
What to do, what attitude to keep in case of convulsion?
As far as possible, the parent is invited to stay calm with his child and observe the movements produced during the convulsion: movement on one side or both, movements of the mouth, eyes, etc.Any precision will be useful in the event of a call to 15.
Some reflexes can also be useful depending on the specialist:
In what case should we call the SAMU?
Epileptic crises are emergencies.For the pediatrician-resuscitator, it is not a good idea to run with his doctor even if the crisis is short, during a temporary viral affection with fever and that the child seems completely normal afterwards.
The situations that require contact the center 15 as quickly as possible to intervene with the child are:
In these cases, a SAMU team will be sent to the premises to take the necessary emergency measures.
What will the doctor or the emergency room do?
What interests the emergency doctor in the first place is to have the most elements in hand, and to see how the baby recovers from his crisis.It obviously depends on the convulsion context.It is at this point that all the information can serve him: your observations, your doubts about the absorption of a drug or a product, the context, the fever present or not, etc.
In the case of a fall, and eye movements which can induce a hematoma in the brain, a scanner will immediately be practiced to know the consequences of the trauma.
In the case of a fever present, the whole question is to discern if it is a feverish convulsion without consequences or an infectious cause.If the child is in the middle of a cold, which he recovers very quickly and seems completely normal, there is a good chance that the feverish and benign cause is the norm.In case of doubt, the hospital will carry out additional examinations:
Will the child keep the consequences of these convulsions?
In the case of a benign crisis, and a rapid return to the normal state, no concern, the epileptic crises will leave no sequelae to your child and will only be a bad memory for the parents.
For the rest of the causes, the emergency room recalls that everything is done to avoid the consequences of your child, and that rapid care limits the risk of sequelae.But the answer can only be given on a case -by -case basis depending on the cause and the convulsion context.
Source 1: 2 to 5% of children experience febrile crises, the feverish crisis, sfpediatrie.fr site
Resources: Fébrile convulsible crises of the child, ameli.fr site
A lire aussiAuteur : SMagali Régnier, journaliste santéExpert : Dr Jean-Louis Chabernaud, pédiatre-réanimateur à l’Assistance publique - Hôpitaux de Paris, auteur du Grand livre de mon enfant, Eyrolles 2016 Article publié le
