The child falls and convulses, is it a fall or a fall?

For medical professionals only

At home during the epidemic, we must also always pay attention to the status of our children.

A few days ago, the spring baby, a 3-year-old boy in the epidemic prevention and control home isolation, suddenly fell and convulsed, and was urgently sent to the hospital pediatric emergency department by 120 ambulances.

Convulsions and falls are common emergencies in pediatrics, is the baby falling or falling? "Falling" means that the fall causes convulsions, and "jerking" causes convulsions. Who is the antecedent and who is the consequence? Cause and effect are different, diagnosis and prognosis are different, and it needs to be clarified as soon as possible.

【Diagnosis and Treatment】

Pediatrician

Hello, don't worry, the child is no longer convulsive, clear-headed, rosy-faced, breathing steadily, and beating strongly. There is no abnormality in cardiopulmonary and cerebral function, but the spirit is slightly worse and the appearance of wanting to sleep. The child's head and whole body did not see any signs of the fall, and the fall should not have been too heavy at that time, right? How did you find out he was twitching? Do you fall down first or convulse first?

Parents of children

It was in home isolation, he got up in the morning and played at home by himself, bouncing around. Grandma saw him suddenly fall and immediately went to help him up, only to see him convulsing all over his body, twitching his limbs, spitting foam, and rolling his eyes up. Frightened, we quickly laid him flat on the floor to keep him breathing smoothly, and at the same time called 120 emergency and reported to the building manager and the community epidemic prevention and control personnel. We saw that he fell first and convulsed later.

It doesn't have to be a jerk, maybe it's a jerk, it's a child who convulses, a limb that falls weakly, and the fall you see is just the result and manifestation of the convulsions. The causes of jerking are complex, so I'd like to ask you some questions. How long does the child probably twitch?

About 3-5 minutes, right? Maybe 1-2 minutes? By the time the 120 emergency doctor arrived, he had stopped convulsing himself.

Has your child had fever, cough, diarrhea, or vomiting recently?

No, daily monitoring of body temperature and nucleic acids is normal.

Did the child eat before convulsing? Have you been in the sun lately? Did you supplement with vitamin AD?

Before the convulsions, there was no time to eat. Recently, home isolation does not allow to go out, there are 5 days without going out to bask in the sun, occasionally on the balcony through the glass to dry. Vitamin AD has not been supplemented for 2 months, the child has been 3 years and 2 months old, does not mean that this vitamin AD can only be supplemented to 3 years old? Eat every day until the age of 3.

Has your child twitched before? How many convulsions have this been?

No, this is the first convulsion.

Did your child be screened for genetic metabolic diseases at birth?

Newborn screening has been done, there are no genetic diseases, and they are normal before.

The child's height and weight look good, and the physical growth and development are normal. The child's intelligence and motor function are not abnormal, right?

No, very smart, climbing high and low all day, bouncing around, super energetic.

There are many reasons for children's convulsions, now, the child's heart, lung and brain function are stable, first take the child to take a skull CT, to exclude the internal brain injury caused by the lower trauma; then draw a blood, test the child's blood routine and inflammation indicators, blood sugar, blood gas, blood biochemical potassium, sodium, chlorine, calcium plasma concentration, and heart, liver and kidney function, etc., and so on, and then analyze and evaluate the cause of the child's convulsions.

【Case Puzzle】

▍First, clinical condition analysis and confusion

After 2 hours, all the test results came out and there were no abnormalities. The baby also woke up and rejuvenated.

The child said that he was not uncomfortable. The pediatrician also faced the parents and made the following diagnosis and treatment analysis and treatment plan for the child's condition.

1. The child currently has nothing uncomfortable, the physical examination does not find pathological manifestations, all examinations have no abnormal findings, coupled with the child's appearance is not obviously broken, can exclude serious diseases such as internal brain injury, bleeding, tumors, etc., combined with laboratory examination, can also exclude intracranial infectious diseases.

2. What is clear at the moment is that the child is "falling", not "falling". The child convulsed first, and his limbs fell weakly. When the convulsions were small, the parents did not find out, and the convulsions fell down and the action was large, and the parents found out. If you "fall", the problem is serious, it is a convulsion that occurs after a head fall injury, and there will be abnormal performance in the skull CT and other examinations.

3. The most common convulsions in children are febrile convulsions, which are benign convulsions caused by fever, which is a common condition in developing children, and most children will be fine when they grow up. However, the spring baby has no fever before and after the convulsions until now, which can exclude febrile convulsions.

4. Spring baby 3 years old, is the first episode of no heat convulsions, and is in the fasting hunger occurs, many days without sun, 2 months without vitamin AD supplementation, first consider these 2 and nutritional relationship is relatively large diseases: hypoglycemia; vitamin D deficiency hand and foot twitching (also known as vitamin D deficiency hypocalcemia convulsions). Second, consider epilepsy. Epilepsy is characterized by recurrent seizures, not only this time, EEG abnormalities are an important diagnostic basis, need to go to the children's specialist hospital as soon as possible.

5. At present, children can first strengthen nutrition and sun as much as possible, supplement vitamin AD and calcium, and do not let children go hungry. In this way, hypoglycemic convulsions and vitamin D deficiency hypocalcemia convulsions can be avoided. If there is no more convulsions after returning home to ensure that the child is nutritionally adequate, you can go to the children's specialist hospital for an EEG after 15 days to further confirm the diagnosis. If the EEG is normal after 15 days, treatment can be left untreated.

6. After returning home, when you observe and strengthen nutrition at home, and find that your child has convulsions again, or any abnormalities such as fever, diarrhea, etc., you need to seek medical treatment immediately. For the next visit, go directly to the Children's Specialist Hospital.

▍2. Hypoglycemic convulsions in children

Hypoglycemic tics in children are convulsions caused by abnormal brain function due to lower blood sugar. Hypoglycemia is the most common metabolic disorder in children, especially in newborns and infants, recurrent episodes or persistent hypoglycemia, which can lead to irreversible brain function damage in children, which in turn leads to children's growth retardation, severe low IQ, and even death.

The diagnostic criteria for neonatal hypoglycemia within 28 days after birth are < 2.2 mmol/L, and the diagnostic criteria for hypoglycemia in children of other ages are the same as those in adults, with fasting blood glucose concentrations below 2.8 mmol/L, and blood glucose values below 3.9 mmol/L in children with diabetes can diagnose hypoglycemia. Hypoglycemia is more damaging to children, especially infants and young children than adults, and clinical timely diagnosis and treatment are extremely important.

▍3. Vitamin D deficiency hand and foot twitching

Vitamin D deficiency hand and foot twitching, also known as vitamin D deficiency hypocalcemia convulsions, is one of the concomitant symptoms of vitamin D deficiency rickets, most common in infants within 6 months, but also in older children with nutrient deficiency, insufficient sun exposure, and rapid growth and development.

Vitamin D deficiency hypocalcemia convulsions are diagnosed on the basis of sudden, nonpyretic convulsions, recurrent seizures, post-seizure alertness without neurological signs, and the presence of rickets, with total blood calcium below 1.75 mmol/L-1.88 mmol/L and calcium ions below 1.0 mmol/L.

Vitamin D supplementation and sun exposure are the main measures to promote calcium absorption and prevent vitamin D deficiency hypocalcemia convulsions, and calcium supplementation can also be appropriate. Vitamin D is necessary before the age of 3 years, 3 can also be supplemented subsequently, can be supplemented for life, and now many scholars advocate supplementation to 5 years old. Regardless of age, supplements are needed when your child is growing faster and may not be able to keep up with nutrients.

▍Fourth, children's epilepsy

Epilepsy refers to a long-term recurrent convulsion in the absence of fever or other precipitating convulsions in children, at least two or more convulsions. A history of recurrent seizures and electroencephalogram abnormalities are important bases for diagnosing epilepsy. Epilepsy is a common chronic neurological disorder in children and requires long-term follow-up by a child neurologist.

Expert Profiles

Xu Lingmin

Chief Physician of pediatrics and director of the Teaching and Research Department of Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Doctor of Medicine; Member of Pediatric Branch of Shanghai Medical Association and Medical Association, Member of Science Popularization Branch, Member of Pediatric Cardiovascular Group, Scientific Debunking Expert of China Association for Science and Technology; Original Popular Science Books "Solution to Common Pediatric Diseases" and "Pediatric Emergency Emergency Problem Solving", answering public parenting confusion. He has won the second prize of the Shanghai Science Popularization Education Innovation Award, the Nomination Award of the Popular Science Award, the Outstanding Popular Science Writer Award and the Excellent Popular Science Book Award, and many other popular science awards, and the good doctor of the year of "Good Doctor Online" and the outstanding author of "Medical Field" for many years.

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Xu Lingmin. Pediatric Emergency Emergency Diagnosis[M].Shanghai:Shanghai Science and Technology Education Press,2020.

Jiang Zaifang, Shen Kunling, Shen Ying. Zhu Futang Practical Pediatrics (8th Edition)[M].Beijing: People's Medical Publishing House, 2015.

Liu Xiangyun,Chen Ronghua,Zhao Zhengyan. Child Health Care (4th Edition).Nanjing:Jiangsu Science and Technology Press,2016.]

This article was first published: Pediatrics Channel of the Medical Professions

The author of this article: Xu Lingmin, chief physician of the Department of Pediatrics, Qingpu Branch, Zhongshan Hospital, Fudan University

Editor-in-Charge: CiCi