Why warmth is a danger

When Jason Bennetto's daughter began to convulse and lose consciousness, he and his wife were terrified. Yet this is a common - and usually minor - occurrence. So why don't we know about it?

It was late on Saturday afternoon and I had just returned from a brief shopping trip with my 23-month-old daughter who was suffering from a winter cough and runny nose. Throughout the day her mood and temperature had been up and down. The on-call doctor told me on the telephone that it was probably a virus doing the rounds in north London – there was nothing to worry about, I should just give her lots of fluids and some Calpol.

As I struggled through the front door with bags of fruit and veg I noticed that my daughter, Robyn, had begun to look glazed. Her eyes were rolling slightly as if she were hypnotised and about to fall asleep. I took her out of the buggy. Her usual zip and cheeky grin had vanished, and she seemed dopey and drowsy. What happened in the next 15 minutes was a shocking, terrifying experience for three adults and one infant. It left me feeling helpless, and later angry that I had not been forewarned.

I carried Robyn downstairs to the kitchen. It was at this stage that I realised something was wrong. Her eyes started to roll to the back of her head and she began to lose consciousness. Her small body then started to convulse and her back began to arch. Luckily my mother was staying with us, helping to look after Robyn and my wife, who had been struck down by a virus and could barely get out of bed. She rang 999.

Meanwhile Robyn's condition was getting worse. She was foaming slightly at the mouth and seemed to be slipping in and out of consciousness.

My mother started relaying advice from the 999 operator – take all her clothes off her and start fanning. As I stripped her floppy body I began to feel panic. By this time Robyn's mother had come downstairs and was holding our daughter's naked body in her arms. Minutes passed and Robyn's convulsions stopped. We craned forward, trying to hear her breathing.

At this stage a paramedic pulled up in a car outside the house. After a couple of questions he gave us the hugely relieving news: "Don't worry, she'll be fine. I deal with this problem at least twice a week."

At his instruction, we placed our still-unconscious daughter on to her back and held an oxygen mask close to her face. The gas quickly brought her round. After a few minutes of tears and looks of confusion, Robyn was awake and clinging to her mummy. An ambulance crew arrived and confirmed that what we had experienced was nothing unusual for parents of young children. We were told it spooked the parents more than the youngster, because almost everyone who witnesses the convulsions for the first time believes that their child is dying.

Robyn had had a febrile convulsion – a reaction that infants and children up to the age of about six can suffer, usually as a result of over-heating. This condition is common. About one in every 33 children aged from six months to six years will experience febrile convulsion at least once.

But surprisingly, almost all the parents, including several grandparents, I have spoken to since Robyn's attack had never heard of the condition.

The good news is that almost all the children who have an attack will not suffer any long-term harm. But a child who has their first seizure before the age of one has a 50 per cent chance of further seizures. A child over the age of one when the first seizure happens has approximately a 30 per cent chance of it recurring. And genetics plays a role in who is likely to get a convulsion. A child is four times more likely to have a febrile convulsion if either parent was affected when young.

Dr Quen Mok, a consultant paediatrician in intensive care at Great Ormond Street Hospital for children in London, explained: "[Febrile convulsion] is the most common cause of fits in the age group six-months-to-five-years." The fit, says Dr Mok, is caused when normal electrical charges from the brain become chaotic, usually triggered by a high temperature. The jerking of the limbs is caused by this abnormal brain activity, which almost always leads to unconsciousness.

Febrile convulsion is caused by the rapid rise in a child's body temperature, up to 38.5C or 39C, usually at the start of an illness. This is because some young children have a lower threshold to having a convulsion, which they out-grow. In about 90 per cent of cases, a viral infection is the cause of the fever. "There is no proven reason why some children fit, while others do not," said Dr Mok.

The attacks are considered "atypical" or potentially damaging if the fit lasts longer than 30 minutes, or if the child is only about six months old and there are no obvious causes. If it is a long fit, there is a greater danger of long-term damage, because there could be a loss of oxygen to the brain. Four to 7 per cent of children who have a fit can have long-lasting (more than 30 minutes) or unusual convulsions. While only a small proportion of these "atypical" fits results in any serious long-term damage, the exact proportion is currently the subject of research.

Disturbingly, some doctors are beginning to believe that the danger in the atypical cases has been underestimated. Dr Rod Scott, a paediatrician neurologist at the Institute of Child Health, said: "The evidence is beginning to suggest that in cases where there are long convulsions they might be potentially more harmful than we have previously thought."

Dr Scott said that between 10 and 20 per cent of people who experienced atypical fits as children develop seizures as teenagers or adults.

One possible outcome of a long fit is scarring to the brain, which can then result in the child suffering from epileptic fits, although this is rare and can be controlled, in most cases, by drugs. But in extreme cases, brain surgery is needed. But Dr Mok stresses: "We would not start worrying unless the fit lasted for longer than half an hour. Most last from five to 10 minutes."

Among the techniques that are used to reduce a fever, and therefore the chance of a fit, are regular doses of Calpol and ensuring that the child is not over-wrapped – a child running a temperature can be dressed in a romper suit, a vest or just a nappy. A damp flannel can be applied to the face and neck, but experts no longer recommend giving the child a lukewarm bath because parents often misjudge the temperature and water that is too cold can cause the core of the body to overheat, as can water that is too hot.

If the child starts to fit, you should lie the child on his or her side in a cot or on a bed or other soft surface, with the head positioned lower than the body. Do not try to restrain the child, but loosen any tight clothing and remove any that may be keeping the child too warm.

If your child is sucking a dummy, gently remove it. The official advice is to stay with the child through the convulsion and, when it's over, to call a doctor or, if it lasts longer than 15 minutes, an ambulance. But in reality, most parents will want to call 999 as soon as possible.

If a child suffers repeated fits or if the convulsions last a long time, Diazepam, a sedative and anti-convulsive, can be given in a pipette via the rectum. Diazepam is provided by hospitals and doctors to parents of children who have had a fit or are likely to have repeated or atypical fits.

Following a precautionary overnight stay in hospital, Robyn has fully recovered since the fit and there appear to have been no long-term effects. But for any parent experiencing febrile convulsion for the first time, it is a terrifying event.

In view of the fact that this phenomenon is so common, and can have long-term side effects, it seems very wrong that there are not more warnings and better information supplied about the what to do if a fit occurs and how to prevent one. Part of the explanation appears to be that medical professionals reason that because it almost never causes any long-term harm, providing such services would be a waste of resources. This seems short sighted. Surely the time and money saved in avoiding trips to hospital, and reducing the anxiety caused to parents, are reason enough.