A. Physical Exam Key Points. Physical exam in children with febrile seizures should be directed at finding a source for the fever as well as evaluating for other possible sources of seizure.
1. Vital signs. Note temperature peak, because some studies show that risk of febrile seizure recurrence is greater with lower temperatures. Hypotension is common in septic children.
2. heent. Inspect head for signs of trauma. Assess fontanelle in children in whom it is still open. Bulging fontanelle could indicate intracranial infection, such as meningitis or encephalitis, or increased intracranial pressure from other causes. Depressed fontanelle may indicate dehydration, with subsequent electrolyte abnormalities leading to fever and seizure. Lack of cooperation in infants and young children may make it difficult to evaluate papilledema. Inspect ears and throat for sources of fever.
3. Skin. Inspect for rashes (eg, viral exanthems and petechiae) and other skin findings indicative of underlying neurologic disorders that could account for seizure (ie, ash-leaf spots, café au lait lesions, or port-wine stains).
4. Neurologic exam. Careful attention to this aspect of exam is important. Prolonged altered level of consciousness or change in child's general appearance requires more aggressive evaluation. Similarly, any focal neurologic deficit demands further workup beyond the scope of simple febrile seizure evaluation.
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