The Febrile Fit

Just two weeks prior to his 2nd birthday, Petit Harris caught another bout of URTI ( upper respiratory tract infection). he had been having runny nose, mild dry cough and a subtle hoarseness of voice for about 1 or 2 days followed by a fever. We had noticed the intermittent fever the day before but thought it is just a low grade temperature, not worth to annoy him with anti-pyretic med and he was jolly well active.
However, the next day, while he was playing around us, he suddenly fell to sit, with a blank stare. his papa quickly took him onto his lap.he continued to be unresponsive to call, stared blankly slightly upward, and his saliva started to drool. there was no jerky movement or limb stiffness. the whole episode lasted for  good 4-5 minutes. i realised he was febrile at that time. trying not to be panicky, we applied wet cloth onto his body and (luckily) i went to Klinik 1  Malaysia earlier that day to get a few packet of suppository paracetamol for home stock ( knowing Harris who will vomit back  syrup med).

he was drowsy for a couple of minutes post ictally, and Alhamdulillah back to his normal self after that. I made sure he had no other neurological deficit ( by doing full neurological examination ).  I don't think he needed any biochemical investigation as the presentation  and age wise was rather straightforward suggestive of simple febrile fit. therefore , i just observed  him at home by taking leave a couple of days. we gave him 6 hourly suppository PCM  with regular tepid sponging especially when he had temperature spike. after tthe fitting episode, i made my husband went to the pharmacy to buy a thermometre stat, for precise temperature monitoring :D

he developed parenteral diarrhea the next day. poor boy had to endure pain from the perianal excoriation. so torturing to see him in such pain every time  he purged. but this forever playful boy is so active in between. running around in broad based gait ( due to perianal pain) and throwing toys all around the house as usual.  we applied topical zinc oxide cream to soothe the discomfort and i think it did work :)  he fully recovered day 3 after the seizure and i can't stop thanking God for the speedy recovery.

One thing i learn from this event was that, fitting was a scary scene especially if it happened to your loved one. i have seen countless febrile and afebrile seizures before, but when it happened to my own son, the emotion and anxiety level were totally different. i was able to maintain good composure through out the event but only God knows how scared I was at that time.

i had a history of febrile fit myself once during my infantile period. so did my younger brother. hence, it was no surprise that it could  occur to my son. May this be first and the last for him. will be more cautious the next time he caught a fever.

je t'aime toujours Harris dear

Harris caught the sixth disease!

to my relief! he 's all better now :D

well, his history of presnting ( more like past) illness are like this :

Harris had caught up symptoms of upper airway infection eversince we came back from Kelantan to visit his paternal great grandparents. He's been having chesty cough and runny nose which irritated him at times. I opted not to give him anything initially but as the cough persisted more than a week, I prescribed Augmentin for him. Had him been any other kid, i wouldn't have done that, but considering his maman works very closely with fatally sick babies and todds , prompted me to start him on the expensive broad spectrum antibiotic. He didn't like it at all though it tasted sweet. In fact, he'd vomit back everything. Harris!! I let him did so in the beginning. but then, he started to become feverish.not good, i thought. though i didn't have a thermometre, i knew it was high grade clinically. I had no choice but to make sure the Augmentin and the antipyeretic paracetamol got in! So, i administered them orally with a syringe little by little. slow and torturous for him but i had to. i thought he'd never like me after that. luckilly he still wants me as his number one favourite ( tapi everytime mase bagi ubat tu nak kat papa je la :p ) , what troubled me more then, the fever resolved for 6 hours then  kept on spiked again as the antipyretic effect faded . despite the antibiotic. He even had lymph nodes! the whole set of neck nodes ; post auricular, occipital , anterior and posterior jugular chains and even supraclavicular. bilaterally!  they were not matted, which was a relief. I was considering to add up EES but then the fever totally resolved after three days. So i didn't. However, later that evening, I received a call from mon cheri telling me that harris developed  rash all over his body. I was on-call that day. A lot of things went through my mind at that instace. could it be measles? could it be chicken pox? could it even be Dengue?? I asked cheri to bring Harris to the hospital later that night but he didn't as Harris slept rather early that night. So I anxiously waited for the clock to turn 5 the next day so that I can see for myself what's going on with Harris. ( On-call during weekdays mean i have to stay in the Hospital from 8.00 am in the morning till 5.00 pm the next day) . But honestly, when I reached home,  I couldn't think of any spot on diagnosis. It was macular papular in nature , no pustules or blisters. didn;t look like a measles at all, definitely not a chicken pox or dengue rash. Therefore, i called up a senior colleague who was fortunately on-call that day, to get her opinion. She was the one, who diagnosed Harris with Roseala Infantum ( also known as the sixth disease) the minute he saw my son. brilliant doc she is!  no wonder the antibiotic didn't work. It was of viral origin! but on my defence, at that point of time, the high grade fever could not rule out bacteria, could it?

thank you so much, mate. after knowing the diagnosis, when i recall  the history retrospectively, indeed it was quite a textbook presentation. Harris oh Harris. maman loves you so much I can't even think straight!

the rashes has gone today. He is back to his normal cheerful mood ;-)

Say Merci for Allah's Mercy

Maman is back in the paediatric department since a month ago. Praise God, I'm right on track in the field I wish to pursue :) and for the past solid 1 month, I was placed to take care of NICU, the neonatal intensive care unit - basically a place to nurse and treat very sickly babies.  whenever I attend to them, i would be reminded  of how fortunate we are compared to the babies and their parents... It s soo sad.  Being a parent myself, I know what every mom would have imagined and expected out of their newborns - a term , vigorous and perfectly healthy child. But that is so not what it turned out to be in their cases. some were delivered prematurely complicated with piles of problems along with it such as immature lungs, heart failure, necrotic intestine, anemia, infections and the list goes on. some were born with anomalies, some with brain damage due to asphyxia during labour, some need immediate surgical intervention.. so sad, so so sad :(


It breaks my heart to see all these. but one thing that keeps me going is I know I am doing something to help them get better even if it could not be fully cured. Every morning, I pray that Allah keeps us healthy and fine as we are now and I  also  pray for the kids under my care to be healed and could be discharged as healthy as any other infants. God willing, they would..

Back to your milestone assessment , little Harris,  speech wise you are now able to babble 2 syllables like 'am ma mam mam' and 'ba ba ba bu ba bu ba'. soo cute! visual and hearing - very sensitive, turning to sound and able to corelate visual and auditory senses. fine motor - still palmar grasping but your pincer grip is developing. Very good at transferring objects and becoming more selective nowadays when reaching out for things. hmm mr picky? :p  gross motor : harris is very good at pulling head from couch , can be pulled to stand easilly, sit with support, able to lift abdomen and thigh but not yet sustained, and as mentioned previously, reversed commando crawling! socially : this little baby is a heartthrob! very charitable with laugh and smile, no stranger anxiety but  can be very picky when he is sleepy at night, only chooses to be carried by maman n nenek huhu ( not even the maid).

Now say, Merci Allah!

peekaboo!

Harris zain

heartmelter

growth and development

i forgot to mention in earlier entry : we brought Harris to the clinic too yesterday ( in between the two photo shop visits). he was supposed to get his two months old vaccination jab but the nurse refused to do so as he is 3 days younger than 2 months old. what pissed me off was the fact that THEY were the ones who gave the appointment date and said it was ok. nurses... sigh. anyway , let's put that aside. 
You Harris, however, was still weighed and measured. 5.3 Kg and 54 cm in length. I am amazed and honoured.me being a paediatrician in the making ( uhuk uhuk) absolutely will chart up your growth even when the nurses didn't ( n i tell you they should!) so here they are :

Growth chart taken from About.Paediatric . click on the picture to enlarge.

 

 

you started off at a 5th centile ( which means 5 % of babies your age weigh similarly or below) and now at two months old you have catched up to 50th centile! that's ma boy :)

i also, just now,  incidentally elicited that you have bilateral ankle clonus sustaining about 3 to 4 beats. made my heart skip a couple of beats before i could think properly again. how could i not be when clonus might indicate a high motor neuron abnormality ( like cerebral palsy for instant)!however,  i believe it is normal to have clonus at this age provided it was not too prolonged and no other signs of neurological deficit. Harris, you are growing well in all aspect - gross motor, socially, vision and hearing - therefore this finding is likely to be part of your normal development eventhough not all infants have it.it'd better be so... we'll see in a few months.

you see mothers, this is the reason why clinic follow up is vital - to ensure that babies grow up well and free from any condition that might not be apparent at birth or early neonatal period and thats why you need to plot the chart so that you know that your child is still within the majority wagon.

The Dilemma

1.Infantile colic and how to solve it

Since birth Harris had never been clad with 'barut' . for the past two days he has. and the difference is remarkable. he is now able to sleep soundly during day time. less crying, n less colic episode ( kembung as my mom called it). thanks to nenek ( maternal great grandma) who made them. now i believe :D

infantile colic is a benign condition though. it's a come and go thing like regurgitation. very common in neonate and usually will disappear by 3 to 4 months old.but having said that, it is still very irritating for babies and to see them in such state is no comfort for us parents either.

2.Regurgitation

Thank God my dear Harris has no major problem so far and i hope it d stay that way forever. I am quite worried about his frequent regurgitation though. at one point i thought it was already a laryngopharyngeal reflux as he experienced hoarseness of voice , and throat clearing episodes. luckily the hoarseness has gone but the throat clearing  is still there particularly in the morning. so far he has no problem thriving and feeds well, therefore leading me to believe it is not yet a disease.if any other mother i would have reassured them that it is not serious and will be self-limiting as babies grow older.but as it happens to me now ( even when i am a potential future paediatrician) , i totally understand why mothers can worry so much even on petty things when it comes to their children. kids... you guys are soo lovable.