There are few data available regarding health services utilization and treatment costs of children experiencing febrile

seizure events. The majority of studies evaluating health services utilization and treatment costs have been in children diagnosed with epilepsy [57-62]. The costs to initially evaluate and treat febrile seizures depend on the clinical work-up indicated by clinical suspicion. In 2003, Freeman detailed the cost of evaluating an initial afebrile seizure in the emergency room (US $3057) and concluded that less testing is needed in the ER following this occurrence [63]. Two studies have indicated that children with febrile seizures do not consume excess health care resources. In a matched case-control study, 75 children experiencing their first febrile seizure were age-matched with 150 febrile and 150 afebrile controls. It was concluded that children with febrile seizures had nearly identical rates of subsequent hospitalization when compared with agematched controls [18]. A secondary analysis of this same data set was undertaken, and it was found that children with a known family history of febrile seizures at the time of study entry had 24% fewer physician visits [64]. In contrast, children experiencing their first febrile seizure had 45% more physician visits when they knew of a relative with afebrile seizures than those with negative family histories. Thus, it appears that knowledge of a family history of febrile seizures is correlated with reduced office visits.

6. Parental Reaction and Response to Febrile Seizures in Children

Top 1. Introduction 2. Febrile Seizures Defined 3. Natural History 4. Febrile Seizure Evaluation... 5. Health Services Utilization... 6. Parental Reaction and... 7. Implications 8. Summary References Parental reaction and response to febrile seizure occurrence in children can comprise physical, psychological, and behavioral manifestations. Common physical symptoms experienced by parents following their child's febrile seizure include dyspepsia [65], anorexia [1], and sleep disruption [1;8;9;65]. Psychological reactions experienced by parents include fear of reoccurrence [8], fear of subsequent development of epilepsy [1], apprehension, and excessive anxiety and worry about low-grade fevers [66]. The occurrence of febrile seizures can potentially disrupt the familial quality of life and the parents may experience anxiety and fear whenever a child develops a fever. These parents may also perceive that somehow the child is now vulnerable or unusually susceptible to medical or developmental problems [18]. The full term to describe this perception is referred to as the "vulnerable child syndrome", which includes a compilation of behaviors that are thought to

develop as a result of this excessive parental anxiety [67;68]. These parents experience increased anxiety and fear [68] whenever a child develops a fever [8;9]. As a result, this heightened parental fear of fever and febrile seizures can have series negative consequences on daily family life [1;4], parental behavior [4;69] and parent-child interactions [68;70;71]. As a consequence of this perceived vulnerability, it would seem intuitive that the caregiver would seek medical attention for their child more frequently, as this was repeatedly found in previous parentperceived child vulnerability studies involving general pediatrics and premature infants [70;7274]. But to the contrary, as noted earlier in two studies [18;64], children experiencing febrile seizures did not utilize a higher rate of resources compared with age-matched controls.

7. Implications
Top 1. Introduction 2. Febrile Seizures Defined 3. Natural History 4. Febrile Seizure Evaluation... 5. Health Services Utilization... 6. Parental Reaction and... 7. Implications 8. Summary References The occurrence of childhood febrile seizures are common; thus parents and caregivers should be provided information about them. Instructions and parental education should be specific, written in lay terms, tailored to their language and culture and address the following (See Table 1): Table 1 Febrile Seizure Information and Education Clinical Education Febrile seizures are convulsions brought on by a fever in infants or small children. Most febrile seizures occur within the first 24 What is a febrile seizure? hours of an illness/fever. Febrile seizures may last from a few seconds to more than 15 minutes. Febrile Seizures occur in 3% -5 % of otherwise healthy children 6-60 months of age. It is debated by experts whether it is the The link between fever and quickness of the rise in temperature or the height of the febrile seizures (FS) in children. temperature which triggers the seizure. The seizure is often the first sign of a fever. During a febrile seizure, a child may lose consciousness or What may happen to the child responsiveness, shake and move limbs on both sides of the during the febrile seizure? body. The child becomes rigid or has twitches in only a portion Clinical Information

Clinical Information

What measure(s) should be taken or avoided during the febrile seizure event.

What does not happen to the child's brain during a febrile seizure?

The likelihood of reoccurrence.

When to consult a healthcare provider, when to call 911 and when take the child directly to an emergency room (ER). What may occur during the healthcare provider's evaluation and/or testing of the child

What are the possible sequelae of febrile seizures?

Clinical Education of the body, such as an arm or a leg, or on the right or the left side only. The child may vomit or pass urine. Do stay calm. Focus your attention on bringing the fever down. Insert rectal acetaminophen (Tylenol) (if available). Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Loosen any restrictive clothing. Don't try to hold or restrain the child or stop the seizure movements. Don't try to force anything into his mouth to prevent him from biting his tongue as this increases the risk of injury. Move the child only if in a dangerous situation. Remove any objects that may injure him. There is no evidence that simple febrile seizures (<10 minutes) cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties. A third of children will have another febrile seizure with a subsequent fever. Of those who do, about will have a 3rd seizure. If there is a family history, if the first seizure happened before 12 months of age, or if the seizure happened with a fever below 102, a child is more likely to have >1 febrile seizures. 1. Children should consult a healthcare provider as soon as possible after the first febrile seizure. 2. Call 911 if the seizure lasts more than a few minutes. 3. Contact a healthcare provider or go to the ER if any other symptoms occur before or after the seizure: nausea, vomiting, rash, tremors, abnormal movements, problems with coordination, drowsiness, agitation, confusion, sedation, etc. Blood and urine tests may be examined to detect infections. Typically, a full seizure workup including an EEG, head CT, and lumbar puncture (spinal tap ) is not warranted. Injuries caused by falling or bumping into objects. Biting oneself Pneumonia secondary to fluid aspiration. Injury from prolonged or complicated seizures. Medication side effects related to the treatment and prevention of seizures (if prescribed). Complications if a serious infection, such as meningitis caused the fever. Seizures unrelated to fever (afebrile seizures) Parental perception of increased child vulnerability to medical or developmental problems.

What treatments may be prescribed (i.e anticonvulsants), The list of epilepsy medications used depends on clinical plan when they are indicated, and devised possible adverse effects.

8. Summary
Childhood febrile seizures, although primarily benign, can be frightening and anxiety-provoking events for parents and caregivers. It is important that health care providers understand potential parental misconceptions, anxieties and fears about fever and febrile seizures so that they may allay those fears effectively. The healthcare provider also needs to assess parental reactions to the occurrence of febrile seizure and to determine the coping patterns utilized as well as to detect any disruptions in parent-child interactions. Additional studies are needed to evaluate the costs of treatment for initial febrile seizures as well as health services utilization.

Formation of Neuronal excitability