Flashcards in Fits, faints and funny turns Deck (19):
Causes in infants and toddlers (6)
Apnoea and acute life threatening event
Reflex anoxic spells
Hypoglycemia and other metabolic
In what age group does cyanotic breath holding usually occur
Older babies and toddlers
Usually resolves by 18 months
Presentation in breath-holding (cyanotic)
Precipitated by crying->hold breath, becomes cyanotic, becomes limp, breathes, then conscious again. No post-ictal phase.
Parents need to be reassured
Pallid spells->what are they, age, presentation, advice to parents
6 months to 2 years.
Head injury->vagal response->bradyC and collapse, become pale and fall. May have eye rolling, iincontinence, tonic contractions, but no tongue biting. When they arouse after 30-60 seconds, may be tired and emotional.
Advice to parents is these are benign, usually resolve before school age, no long term consequences, no evidence of behavioural issues.
When does infantile spasm present, characteristics, EEF, association, treatment
Onset in infancy, peaks at 4-8 months.
Myoclonic epilepsy->flexion of neck and upper limbs, can occur in clusters lasting up to half an hour, jacknife spasms
Associated with developmental regression. May have history of perinatal meningitis or asphyxia.
What features may suggest an underlying metabolic disorder
Causes in school aged children (4)
Description of the event
What the child was doing at the time
Involuntary movements, tongue biting, loss of continence
Change in colour (pallor/cyanosis)
How did the child react following, was there a post-ictal phase
If recurrent->parents should aim to record the episode
Developmental history (infantile seizures, metabolic conditions)
Family history-> developmental problems, febrile seizures, cardiac arrythmias.
Important physical examination
Rarely helpful in between episodes
When would you consider investigations rather than clinical diagnosis
If considering apnea, epilepsy, metabolic conditions.
Investigations and interpretation
EEG->Hypsarrythmia in infantile spasm, 3 per second spike and wave in absence seizures, epileptiform may be seen in epilepsy
ECG->rhythm, PR, QT
24 h ECG-> if arrythmia is suspected of causing syncope
Blood chemistry->hypoglycemia, but unhelpful between episodes.
pH monitoring->apnea in infants may be due to GOR
Generalised seizure types
Focal seizure types
Temporal lobe seizures
Forms of epilepsy
Presentation of complex partial
ALOC, strange sensations, semi-purposeful movements
May have post-ictal phase
Presentation of tonic clonic
Tonic phase: suddent LOC, limbs extend, back arches, teeth clench, breathing stops, tongue may be bitten
Clonic: intermittent jerking movements, irregular breathing may urinate and salivate
Post-ictal->child is tired/sleepy
Counselling parents about breath holding
Cause unknown->slowing of heart, change in breathing patterns. Associated with strong emotions, anger, fear, pain, frustration. Not harmful to child.
Can have blue or pale spells. Pale less common- following an injury. No treatment needed if child is able to recover by themselves.
`1. lay them on their side and watch them, remove objects
2. Your child will start to breathe on their own.
3. Do not put anything in their mouth, including your fingers.
4. Once recovered i-> Don't punish or reward them or make a big fuss.
5. Not to 'give in' to your child to stop another attack from happening in the future.
6. Distraction may be a good way of avoiding a tantrum and a resulting breath holding spell
When to see a doctor with breath-holding spell
Seizure > few minutes, then confused/drowsy
Becomes very pale/unconscious for no reason