Meningitis and Febrile Convulsions in Children

Wendy Turner: In today’s health check Dr. Su Laurent the Consultant Pediatrician from Barnet Hospital and the baby channels medical advisor has joined me to tell parents through two conditions, which cause a great deal of worry and anxiety; Meningitis and Febrile convulsions. Hello, Su. Su Laurent: Hello, Wendy. Wendy Turner: Alright, let’s talk with Meningitis. What exactly is Meningitis? Su Laurent: Meningitis is an infection of the meningi and the meninges are the coverings of the brain. So, if as you can imagine, if you get an infection at that area you will have the symptoms, which will include headache, vomiting, and if your baby irritability, high fever, and looking generally very unwell. Wendy Turner: Is this one of the classic symptoms of stiff neck? Su Laurent: A stiff neck absolutely. Particularly in older child, the inability to bend the neck forward likes that because everything is so painful because the meningis go around the brain, and then they go down the spinal cord as well. So, the whole thing becomes very, very stiff. Wendy Turner: Of course, like any illness in a small child or a baby in particular. What does the parent, should she look out for? Su Laurent: Well, I think it’s very important, it’s just why children are so different from adults and we shouldn’t treat them just like small adults. The baby with Meningitis all you may get is irritability excessive crying, high fever, being of their feeds, vomiting something, which makes you feel, I’m worried about my baby, that’s what you might say, see you may will get any neck stiffness at all, they would be able to say, I’ve got a headache. Wendy Turner: Of course this is the problem. Su Laurent: This is the problem. There are two forms of Meningitis largely, if you look at the two groups; one is viral Meningitis, which on the whole gets better whatever you do, but the salt that we more commonly in hospital is bacterial Meningitis and one of these particularly is associated with a rash, I think many of our view is will know about the rash because actually it’s very commonly known about, I think I want to describe that now for today’s people who don’t know. Wendy Turner: Absolutely. Su Laurent: The rash of Meningococcal Meningitis is a classic rash, which looks a bit like a bruise, it looks likes there sort of blood is leaked under the skin and people may have heard about something called the tumbler test. What happens is with a normal rash, if you press and I’ll just show you with these glass tumbler, if you press a tumbler over the patch of a normal rash and you look through the glass what happens is, is what we called blanching; in other words, the redness goes away. But if you push tumbler over a patch of meningococcal rash or if you put it an over bruise it’s the same thing, it doesn’t go away. Wendy Turner: You still see it through the glass. Su Laurent: You can still see it through the glass that’s what’s called the tumbler test. If you see a child with a rash like that or even a little tiny red spots that again don’t go away we called them petikei, they just don’t go away. Wendy Turner: Could they be on any part of the body? Su Laurent: They can be on any part of the body at all. It’s very important to see medical attention urgently. If actually -- so important the GPs who see children like this with a sort of rash and a sort symptom, they always carry antibiotics with them and they will give an injection into the muscle quickly of an antibiotic, as soon as they see a child. So the way of seeking health is to go either to your GP, if your GP is very near or call a GP and say, what do I do or to go straight to hospital or even just to call 999, if you see that rash in an irritable baby or child. Wendy Turner: I’m sure you would also have seen heart breaking stories about infants who’ve had to have limbs and protecting. What is the complication being in that set of rash? Su Laurent: Well, I would say, one thing that’ll to just clarify is that Meningitis, and then the septicemia. Meningitis as when it just affects the brain and therefore you get a very audible child, but the rest of the body is usually okay, they make it a horrible rash, but as the body is usually okay. The septicemia, it means of the bacteria is actually in the blood stream as well and the rash can become extensive, it can go all around the limbs, it can appear as you’re watching a child, I mean it’s just terrifying to watch it. I’ve seen children, who have lost limbs because the rash is so extensive and it’s affected the blood supply to such an extent that the only thing that you can do is actually to remove the limb. So, it’s a very, very serious life threatening condition. Unfortunately, for some of the Meningococcal, we actually now have a vaccine and in fact all babies now are given as part of that routine immunizations at two, three and four months, they give most men C vaccine and that’s against to meningococcus type C. Wendy Turner: Yes, my children will have that. Su Laurent: That’s right. It means we’ve actually reduced meningococcal -- Meningitis and septicemia quite considerably. We haven’t got rid of it and the reason we haven’t go rid of it is because when not protecting mens against meningococcus A, which is the other recently common one or B which is much rarer, and the work is going on with vaccines to the other two. Wendy Turner: Actually, I can’t let this subject go on Meningitis without having little say -- so I actually have Meningitis last year, viral Meningitis. My only -- going to be is that, I’m an adult and I can talk and I can say, I’ve stiffed necked and lot of time been sick. I feel really, really ill, my head actually killing me. Two doctors sent me home and I think my advice would be if you really believe that you’re child is ill just don’t give up. Su Laurent: Yes, I think that’s a very, very important point, but a particularly because early on in the illness, you may look relatively well, but you may feel absolutely awful. Sometimes we can be fooled, older children who have symptoms just like adults. So, and in fact, it’s very often in young adults who will get meningococcal disease and Meningitis that, that’s the particular group, it’s the student who all living together in student accommodation and tend to get it. So older children and young babies are the very venerable group, but obviously adults of any age and it’s very important that we do take children seriously. Wendy Turner: Absolutely yes. Okay, the second sort of the point of worry that I mentioned in the introduction. Febrile, febrile convulsion, I think about this is --? Su Laurent: You said that right, yes. Febrile convulsion. This is the opposite end of the scale completely in terms of anxiety. These are very common problems, which can affect children after the age of five, what happens if they have a high fever, there are no normal child that have a high fever and they have a convulsion, which means generalized shaking all over, eye rolling, often a very funny breathing pattern and terrifying to watch. Parents are often coming and say, I thought my child was going to die. Wendy Turner: Is a child that actually unconscious when they have an neck problem? Su Laurent: The child is unconscious while having a convulsion, which is why they look like they’re going to die? Wendy Turner: How scary? Su Laurent: It’s a very scary for the parents, but the reassuring thing is that the vast majority of children will just come out of the convulsion all by themselves, they wouldn’t think about it, they’ll look around and think, why is everybody so worried. It will not affect them in the long run and it’ll not cause long-term brain damage and this is not epilepsy. These are the important that leaves a stress to parents and really that the take home message with febrile convulsions as they have many have a high fever in otherwise normal child. Let all children will get and then that some children and really try to avoid high fevers if you can. So, if you notice your child is getting a cold and the temperature is going up keeping cool, take off their clothes rather than piling on clothes you know how often people tend to feel; oh, my child is got a temperature and you should wrap them up warm. Wendy Turner: Yes. Is it easy? Su Laurent: You should do the opposite. As you strip off your child, give them some paracetamol or some -- whatever it is, you have a home for temperature and tepids sponge them if they are very hot, they keep in cool. Wendy Turner: What are the different symptoms in between that -- you know the convulsion, a new set of this don’t automatically think it’s -- how could you tell? Su Laurent: Yes. Well, a convulsion is a convulsion and it’s begin, but you don’t really know, but if you’ve got a high fever in under five year old and when they come around, they’re absolutely fine, they’re otherwise is completely normal child. The child’s were being epilepsy is very, very small. You can never say, never in medicine that a chance of being epilepsy is very, very small and the vast majority of children with febrile convulsions. If they’re fine, when they wake up again and they’re very often and to have a little sleep and they’ll sleep and they’ll wake up. We know that they are not going to -- any difficulty. They may have them again febrile convulsions, but it’s not same thing is epilepsy. Wendy Turner: How long would a convulsion lasts whole? Su Laurent: Convulsion could be seconds, just a few sort of jerking before you it hits all over, it can be minutes. Very occasionally, children could have prolonged convulsions and by prolonged, I mean more 20 minutes. Those children will land up coming rapidly into hospital by bought in by ambulance and the ambulance has some medicine that can be given into a child’s bottom to stop the convulsions. Very often the convulsion would have stopped already in the ambulance by the time they come to see -- but if not, we can give the medican, viral vein or viral bottom to stop it in casualty. Wendy Turner: Is there is any particular position that you should get your child into if they’re having a convulsion? Su Laurent: Yes, and ideally, put them into what we call the recovery position, which means to lie them on their side somewhere safe, so obviously not at the high surface, but just on a flat surface, it’s maybe on the ground, so in the best place to put them. On their side, so they cannot inhale their tongue, but never ever put your fingers into a child mouth, which is having convulsion or an adult. Many people think it’s a good idea because why they might swallow their tongue or they’ll do it seriously bite your finger. Wendy Turner: ooh? Su Laurent: I think it’s nasty injuries, they’ll not sort of the tongue provided that they’re lying on their side, but the head on one side. Wendy Turner: Excellent. We’re not roughing that so -- excellent advice on those two very worrying subjects, but I hope will -- today. Thank you Su very much. Su Laurent: Thank you.