It was just a little diarrhea, why did the child have seizures? | Guokr Patient

I am a mother who is used to being fully prepared for everything. Long before my baby was born, I had already done my homework on all aspects related to infants and young children, and I paid special attention to common health problems in children. Unless my baby is gifted with a difficult and complicated disease, daily fever, vomiting, diarrhea, eczema, foreign objects stuck in the throat, etc. are all within my expectations.

Unfortunately, man proposes, God disposes. My little baby, who was born healthy and basically disease-free, gave me a shock just after he turned one year old. When I recall the ups and downs in between, I can’t remember some of them, but I’m afraid I’ll never forget the feeling.

Xiaobao was twitching and I thought he was choking.

In late June 2017, when Xiaobao was one year old, my husband and I took him to Dali, a place with four seasons of spring, for a week. Although we were very tired, the whole trip went very smoothly. Xiaobao was very happy to eat, drink and have fun with us. During the period, although Xiaobao's stool was a little unformed, it was still maintained at a frequency of once a day, and there was no sign of discomfort.

The flight back to Beijing was at noon, and we got up in the morning to pack our luggage. Xiaobao finished his milk, changed his clothes, and wandered around the house with a biscuit in his mouth. After a while, he walked to my side without a word, and suddenly fell to the ground with a "thump".

I thought he had slipped, and when I looked over, I immediately realized something was wrong. Xiaobao was lying motionless on the ground, neither crying like usual nor trying to stand up. I looked closely and saw that his eyes were rolled back, his lips were black and purple, and his body was shaking slightly.

I was shocked, thinking that he had choked on the biscuits, so I quickly called my husband to come over, turned Xiaobao over and put him on my knees to give him first aid. After 1 minute of tossing and turning, Xiaobao finally slowly returned to normal.

Seeing that Xiaobao was fine, we set off for the airport as planned. Due to heavy rain in Beijing, the flight was delayed, so I took Xiaobao to the mother and baby room to play with toys to kill time. At 12:30, Xiaobao suddenly felt a little strange again. His eyes rolled up and his body was about to fall down again. Fortunately, I kept an eye on him and quickly caught him. He looked exactly the same as in the morning. Although I was confused about why he choked without eating the biscuits, the situation at that time did not allow for much thinking. I quickly turned him over and gave him first aid, while shouting for help. The airport staff came over after hearing the noise, and after a minute or two of tossing, Xiaobao returned to normal.

We immediately decided to take him to the hospital. The airport immediately dispatched a car, accompanied by a person in charge and a staff member, and we rushed to the hospital at lightning speed.

After spending a night in the emergency room in Dali,

Xiaobao smoked several times again

Unlike what we expected, after asking about the situation, the emergency doctor thought that it was not choking, but unexplained convulsions, so he ordered an EEG, brain CT, chest and abdominal CT, and a blood test. However, since there are many reasons for convulsions in children, the doctor still recommended hospitalization for examination to determine the cause of the disease. We thought that we were unfamiliar with Dali and had no one to take care of us, and that Beijing's medical conditions were better after all, so we decided to stay in the emergency room for only one night and return to Beijing the next day.

Before the observation, the doctor asked if the child had vomiting and diarrhea. I said no, but Xiaobao vomited once and had diarrhea twice that night. At around 7pm, he convulsed again. The doctor laid him flat and turned his head to one side to prevent suffocation. After a minute or two, Xiaobao recovered.

At night, my husband and I took turns sleeping. I slept very lightly and seemed to have had countless dreams. I barely slept until 11 o'clock. I couldn't fall asleep, so I took shifts with my husband. At almost 3 o'clock, Xiaobao suddenly woke up and refused to sleep with a spirited look on his face. I gave him some water and sat on the bed to watch him play. While he was playing, he suddenly stopped moving and rolled his eyes upwards. I knew something was wrong and quickly rang the bell to call the nurse. The doctor looked at the frequency of his convulsions and gave him an injection of anticonvulsant medicine, which lasted for 4 to 6 hours.

In the morning, around 9 o'clock, just as we were about to leave, Xiaobao suddenly had another seizure! Seeing this, the doctor strongly requested hospitalization, otherwise if he got sick on the plane and developed other dangerous symptoms, no one could predict the outcome. I truly experienced what a "dilemma" was at the time, and called my grandparents to discuss it briefly. Considering that I would need to do lumbar puncture and other examinations later, and I was not familiar with the level of the local hospital, I was really unsure, so I signed the "Disclaimer of Consequences" with tears in my eyes.

We boarded the plane with trepidation, carefully observing Xiaobao's condition. He slept for more than an hour on the plane, woke up and played for a while, and suddenly his eyes slanted and he started twitching again. After so many times, my husband and I have gained experience, so we didn't alert the crew, but just let him lie on our knees and turn his head to the side. After less than a minute, Xiaobao slowly returned to normal.

After a long and anxious journey, the plane finally landed at the Capital Airport.

A series of inspections kicked off

We wanted to let Xiaobao go home to rest and go to the Children's Research Institute on Sunday. Unexpectedly, while waiting for the car at the airport, Xiaobao had another convulsion, only two hours after the previous one, and the interval between the attacks was greatly shortened. We did not dare to slack off, so we went home to pack up and went straight to the emergency room of the Children's Research Institute.

After a simple checkup, my grandparents took Xiaobao to rest on a bench outside while I discussed hospitalization with the doctor. When I came out to get the receipt to pay, Xiaobao had another convulsion! We quickly took him to the clinic, and the doctor immediately performed a lumbar puncture to test the cerebrospinal fluid to rule out brain disease, and prescribed intracranial pressure-reducing drugs and cephalosporin infusion for him.

When doing the lumbar puncture, the doctor used some anesthetic, and Xiaobao did not feel any pain, but he was required to lie flat for 6 hours after the lumbar puncture, and his head could not be raised to avoid headaches caused by changes in intracranial pressure. This requirement is really a bit high for a child over one year old. It was already 6:30 pm when the lumbar puncture was completed. Two hours later, Xiaobao woke up and wanted to get up immediately. My husband and I tried every way to coax him to lie down for another 4 hours. At 12:30 in the middle of the night, the observation period of the lumbar puncture passed safely. When the infusion was finished, it was already past 1 am when I got home.

We got up early on Sunday and rushed to the Children's Research Institute to complete the hospitalization procedures for Xiaobao. The little guy officially began his first hospitalization in his life. Since the infusion the night before, Xiaobao has not had any convulsions again. I think the medicine is the right one.

Generally, when unexplained convulsions occur, hospitals will require hospitalization, on the one hand to prevent accidents, and on the other hand to facilitate various examinations to find out the cause. Xiaobao's examination schedule is very tight. In addition to infusion, blood drawing and urine and feces, there will be electroencephalogram, nuclear magnetic resonance, abdominal B-ultrasound and other examinations in the next two or three days.

Considering the need for breastfeeding, the Institute of Child Health allowed mothers to stay with me at night. The bed was only 1 meter wide, and Xiaobao and I squeezed on it seamlessly. I had to be very careful not to press his little hands and feet. As long as he moved a little, I would wake up immediately. Maybe because he was lying next to his mother, Xiaobao didn't cry, but just lay quietly beside me.

The results of the cerebrospinal fluid test came out one after another, and they were normal. The blood and stool results were also normal. We breathed a sigh of relief, as these results basically showed that there was nothing wrong with Xiaobao's brain, heart, lungs and other important organs.

Can gastroenteritis also trigger convulsions?

Three days later, all the tests were done, and the doctor's final conclusion was: mild gastroenteritis caused benign convulsions. Judging from the test results, the doctor may not have completely confirmed the cause of the convulsions in the end, but only judged based on the three points of "all tests were normal + unformed stools and mild diarrhea symptoms + convulsions stopped after taking ceftriaxone", and tended to think that the cause of the convulsions was gastroenteritis.

Looking at this result, I asked a question that countless friends have since asked me: "Can gastroenteritis also cause convulsions?"

According to the doctor's explanation, it might be because Xiaobao was traveling outside of town for the first time, his irregular lifestyle and excessive excitement caused his body's resistance to decline and he developed symptoms of mild gastroenteritis. His nervous system is more sensitive to gastroenteritis, so although his body has not yet reacted to the disease and he can eat, sleep and play, his nerves have already failed.

I had done a lot of preparation for that trip. I brought not only medicines for common diseases such as colds, fevers, coughs, diarrhea, but even gauze. But plans obviously cannot keep up with changes. Who could have thought that Xiaobao would get sick in such a strange way? He had never had a seizure even when he had a fever of nearly 40 degrees, but was actually knocked down by a "mild gastroenteritis" with no obvious symptoms.

After asking about the cause, I asked about the prevention plan. The doctor said that it cannot be prevented and the child will be fine as he grows up. If you must pay attention to something, then don't travel abroad before the age of 3.

Well... just save money...

From then on, whenever Xiaobao had diarrhea, we kept a high level of vigilance. Fortunately, Xiaobao's motor development was fine. When he was over 2 years old, near mid-December, he had another gastroenteritis seizure and was taken to the hospital. The doctor gave him a transfusion of cephalexin and he recovered.

Later, I searched for "gastroenteritis convulsions" on the Internet and saw many cases. But when I looked through the parenting books on the market, most of them only wrote about high fever convulsions, and almost none of them wrote about gastroenteritis convulsions, let alone "mild gastroenteritis may also cause convulsions."

If it were any other disease, it would be fine, but the visual effect of convulsions is enough to scare any old mother to death. I wrote this article in the hope that it will help everyone understand the manifestations, coping methods and possible causes of convulsions, so that if you get it, you won’t be too panicked.

Doctor's comments

Wang Bingsong | Chief Pediatrician at Wuhu First People's Hospital, Columnist for Pediatric Time at Dingxiangyuan

Gastroenteritis-related convulsions are also clinically known as "convulsions with mild gastroenteritis" (CwG). They often occur in previously healthy infants and young children aged 6 to 24 months with no history of convulsions. There will be one to several convulsions during the course of the disease, and most of them are afebrile convulsions. Most children have symptoms of vomiting and diarrhea before convulsions, but a few children have vomiting and diarrhea after convulsions. In recent years, there has been an increasing trend in domestic and foreign research reports on this disease, but it is mainly seen in the Asian population.

It is generally believed that gastroenteritis-related seizures are closely related to viral infection and immune damage caused by infection, especially rotavirus and norovirus. Therefore, the incidence of gastroenteritis-related seizures will increase significantly during the rotavirus enteritis epidemic season every year. Others such as coxsackievirus and enteric adenovirus are also important pathogens, and a small number of children may also be induced by bacterial infection.

Since most of the diseases are benign, clinically speaking, symptomatic treatment is usually sufficient in the acute phase, such as reducing or removing inducing factors, keeping quiet, protecting the gastrointestinal mucosa, regulating intestinal flora, etc. Anticonvulsant treatment can be given if necessary.

This disease is more common in autumn and winter, which is the same as the onset season of rotavirus infection. However, in Yunnan, due to different climatic characteristics, the onset season of rotavirus is not particularly obvious, so it is possible to get sick all year round. The child in the article first got sick in Yunnan in late June, and vomiting and diarrhea did not appear first, but gastrointestinal symptoms followed by convulsions. This situation is very easy to be ignored and needs to be taken seriously.

However, the author of this article was very careful and had noticed that the child had unformed stools long before he had convulsions, but he did not show typical symptoms of gastroenteritis.

Another problem is that the child had 6 convulsions during the first attack. For a few children with frequent convulsions, some organic diseases, such as encephalitis, need to be ruled out, so cranial MRI, cerebrospinal fluid and electroencephalogram examinations are required. In addition, since most gastroenteritis convulsions are caused by rotavirus infection, it is recommended to do a fecal rotavirus antigen test at the same time as the routine stool examination of the child to better determine the cause.

In mid-December 2018, when the child was over 2 years old, he had another gastroenteritis convulsion. Parents are reminded that a small number of children who have had gastroenteritis convulsions are still at risk of another attack and need to pay attention.

Children with gastroenteritis convulsions generally do not have their nervous system development affected. Long-term follow-up data from most domestic and foreign scholars have not found any obvious sequelae of the disease, and the growth and development and intelligence level of the children are not affected, and the prognosis is good. Therefore, parents should not have too much mental burden, but for safety reasons, they can go to the child health clinic for a developmental behavior screening every 6 months until the age of 3, so as to promptly detect possible problems in a few cases.

Finally, the author of this article was able to handle the baby's sudden problems calmly and calmly, and her knowledge was very broad, which fully reflects the characteristics of young Chinese mothers in the new era. They are good at learning, have a strong ability to accept new knowledge, are capable and competent, and deserve praise!

By Just Harry

Editor: Li Xiaoqiu