 Hello, good day everybody, I am Dr. Naresh, consultant pediatrician from Manipal, Malaysia. Today I will talk about a very simple topic but which frightens most of the parents. Common emergencies which we encounter among children at home, we will discuss about convulsions or seizures, high grade fever at home and what to do when a child falls down at home. Basically the management to be done at home before reaching the hospital. So first we will talk about convulsions and febrile seizures. Convulsions will usually occur in a child who is having a past history of seizure disorder or it can occur for the first time and febrile seizure will occur in a child who is having high grade fever. So always a child who is convulsing it is a very frightening episode for the parents and the whole house gets very panicky and they will not understand what to do. So here are a few things to keep in mind which may help you. Most commonly a febrile convulsion will occur in a child between the age of 6 months to 5 years of age and it will occur when the child is having a temperature above 101 usually. During an episode what you need to do, sudden abnormal how to identify a convulsion, sudden abnormal body movements, uncontrollable body movements and loss of consciousness and twitching up rolling of eyeballs or tight clenching of the teeth these may be present. So once you identify these things in your child the first thing to do as parents or attenders is do not panic that is the most important thing to keep in mind don't panic stay calm and place the child in a safe position. What will be the safe position for the child who is having a convulsion, place him on the floor with a soft pillow or a soft bed sheet below his head so that it does not hurt him and turn the child to one side preferably the left side such that his mouth is facing the floor as you can see in the photo here the mouth of the child should face the floor and he should be made to lie down flat. Now why to do this is most commonly these convulsions can occur when the child is having some amount of food in the tummy and there is a tendency that they will vomit. So once the child vomits during a convulsion there is a high chance that he will aspirate it that is the food will get into the lungs and he may develop aspiration pneumonia. So what you need to keep in mind is once the child is having a convulsion or an abnormal body movement as parents or attenders you don't panic you place the child on the floor flat on his back then turn him to one side and place a pillow or a soft bed sheet below his neck and head so that it does not hurt him and turn him enough so that the mouth faces the floor in case he vomits the vomiters should come out of the mouth and not get into the body again. So if the convulsion stops within a minute or let us say maximum within two minutes then you can carry the child in your own vehicle to the nearest emergency room see I am repeating again don't take him to a clinic where nothing can be done. You need to take a child who is having a convulsion to the nearest hospital emergency room or casualty in a clinic especially in India there is limited that we can do in case of an emergency situation so it will lead to more panic and waste of time. So please remember once there is a convulsion once you are giving the emergency care at home even if the convulsion stops in one or two minutes or if the child continues to convulse you have to take him to the emergency room or casualty of a hospital he may require oxygen and further treatment will be given there. So I hope this management of convulsion at home was important I repeat again don't take the child to a clinic nothing much can be done there you need to reach a emergency room of the hospital. Now the next common emergency what most parents in attendance face is sudden onset high grade fever so they usually end up in our casualty on a Saturday night or a Sunday night when there is no doctor and when we take the history definitely the child will usually not develop fever just like that there will be a preceding history of cough cold acute food poisoning warm eating diarrhea from three to four days they wouldn't have shown to the pediatrician and Saturday night or Sunday night usually when the pediatric clinics are closed they panic and come running to the hospital so fever is any temperature recorded in the armpit that is above 99 degrees so once you have a child with fever please remember don't neglect it always keep a thermometer at home check the temperature and immediately administer the anti fever medications what we use in India commonly is paracetamol so you need to know the dose from your doctor by visiting him what we give is 15 mg per kg per dose for example if your child is 10 kgs you cannot just tell put half a spoon or put 2.5 ml it is not going to happen that way you're going to give 15 mg per kg that is for a 10 kg child he will need 150 mg paracetamol for a 20 kg child 15 into 20 he will need 300 mg of paracetamol only when you give the correct dosage every six to eight hours can you control the fever now one common mistake what parents do is a two-year-old child who is weighing around 12 to 14 kgs they will see the doctor's prescription which they would have visited one year ago the child would have been around 9 kgs so that dosage they will put for two days fever will not get controlled then they come running to the doctor what happens is continuous high-grade fever if not controlled well will usually lead to gastritis in children lot of gastric secretions eventually it will lead to vomiting stomach upset dehydration so please remember fever if managed timely you can take good care of your children at home first thing to do is be sure of the medication second thing is visit your doctor if you're not sure and follow that way now second common mistake what people do other than giving the wrong medication is suppose the child is having a cold cough and fever even though the child is having high-grade fever they will wrap him up with hot clothes woolens and then wrap with one more woolen bedsheet and then the fever will go up and the two degrees please remember when the child is having high-grade fever let us say above 100 he should be wrapped in thin clothing so that the fever comes down don't over wrap him just because he's having cold cough and make his fever go up sometimes when the fever goes very high in a short duration of time they will throw a convulsion a febrile convulsion will occur so please try to avoid over wrapping the kids next what are the dangerous signs you'll keep in mind any child with fever when it becomes an emergency suppose the child becomes lethargic continuously vomiting for four to six hours no oral intake reduced urine output if these things occur over the period of six to eight hours you need to rush to the hospital don't wait till the next day morning you please reach immediately now when do you know the child is all right when he's having fever he's active and playful his oral intake is good his urine output is good every four to six hours he's passing some amount of clear urine white and clear urine that means the child is fine and you can manage at home so this is about the fever management that has to be done at home again I repeat important things will be give the correct dosage of paracetamol 15 mg per kg per dose has to be given follow the instructions properly don't wrap the child with thick clothes just because he's having cold and cough wrapping with woolens a thick bedsheet will increase the temperature and it may precipitate a febrile convulsion when to be cautious is when he becomes lethargic when the child becomes drowsy no oral intake excessive vomiting you need to rush to the doctor so this is about the management of fever at home and when to reach the doctor immediately and next one more common thing what they encounter at home is a child who falls down I'm sure most of you as parents would have had some incidents where the child or your neighbor's child would have had a fall from the steps from the bed so when to actually reach the hospital on time is very important you don't have to rush for each and every fall what is important is you need to notice the child's behavior after he falls usually a fall from a very less height is not going to be very dangerous suppose he falls from a height of let us say two feet and the fall is on the back or the fall is on the feet it is unlikely to harm the child now what are the danger signs when you need to rush to the hospital after the fall kindly stay with the child and don't leave him alone if he develops drowsiness if he develops continuous vomiting or if there is any cut or bleeding is present over the head anywhere over the head scalp nasal bleeding mouth these three conditions you need to rush to the hospital immediately drowsy child continuously vomiting and any cut or bleeding is present from the body over the head now these three are emergencies where you need to rush other than this if the child is active cries for 10 to 15 minutes then is consolable by the parents consolable by the grandparents take him out the garden to the road show him something divert his mind observe him for a whole day he's active he's playing the urine output is good and he sleeps well he's not lethargic easily arousable child basically resuming normal activity these things indicate that the child is not having any brain injury you can relax and meet your doctor with an appointment but with any of the dangerous signs like lethargy excessive sleeping not arousable child excessive vomiting and any focal deficit in the body not able to move the hands or limbs up rolling of eyeballs or obviously occurrence of a convulsion you need to rush immediately to the hospital so I hope the management of these three conditions the bell convulsions fever and a fall of a child at home you have understood it and wishing all the children good health and have a good day thank you