Once people have heard my reasoning, they can get on board that fever isn’t as big of a deal as they once thought except for one MAJOR question:

What about febrile seizures?

The bottom line is that febrile seizures for the most part have to do with genetics and other uncontrollable issues. It has very little to do with the parent’s treating or not treating fever. Basically some kids are simply more likely to have them than others. You might just consider it a bit of bad luck.

On that note, here are 13 facts about febrile seizures:

1. Seizures can only be classified as febrile seizure if they happen when the child has fever.
2. Most febrile seizures occur on the first day of illness (often before the family knows the child has a fever).
3. The child cannot have a history of seizures or an infection that causes inflammation of the brain (like meningitis).
4. Febrile seizures occur between the ages of 6 months to 6 years (most commonly 12-18 months).
5. Boys are slightly more likely to have febrile seizures.
6. About 1/3 of all kids who have a febrile seizure will have another febrile seizure in their lifetime.
7. Kids with febrile seizures are only slightly more likely to have non-febrile seizures (only 1-2 percent).
8. Febrile seizures involve whole body shaking. If it’s just one sided or one body part, other causes should be considered.
9. Most febrile seizures are less than five minutes.
10. Head imaging (CT or MRI) and EEG (which look at brain activity) are not necessary with febrile seizures.
11. Treatment at the time of a febrile seizure is not necessary if less than 5 minutes.
12. Children with febrile seizures do not need to be admitted to the hospital unless the underlying cause of the fever makes it necessary.
13. Trying to prevent febrile seizures by treating fever aggressively has not been shown to be effective.

These are the 13 facts that I walk through with all of my families who have experienced a febrile seizure.

Hopefully knowing the facts will decrease some of the fear and relieve some of the guilt that has been placed on them for not preventing febrile seizures by catching fever in time.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

According to researchers at Albert Einstein College of Medicine in New York, HPV raises the chances someone will get head and neck cancer by at least sevenfold.

For their study, 96,000 people took a mouthwash test for oral HPV infection. Four years later, 132 of them developed some form of head and neck cancer. People infected with a strain called HPV-16 were between two and 22 times as likely to be in the cancer group.

"This study backs up knowledge we already have about how common HPV is and how significant its association with cancer is," said Jason Terk, M.D., a pediatrician at Cook Children's primary care location on Keller Parkway. "HPV is an infectious disease and we all need to be concerned."

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

But there is good news. HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9. And a new version of HPV vaccine, approved earlier this year, has even more cancer protection.

"Only 39 percent of adolescents in the U.S. have received the HPV vaccine. Here in Texas, that number drops to 33 percent," said Dr. Terk. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Some parents may feel uncomfortable talking to their children about the HPV vaccine. For those parents, here's Dr. Terk's advice:

• Explain that the vaccine protects against a very common infection that causes cancer

• · Most people (80%) will get infected with the types of HPV that can cause cancer

• · HPV vaccination equals cancer protection

• · It is best to get the vaccine at 11-12 years of age with the other adolescent vaccine; it works best at this age.

Also good to remember, research shows that youth who receive the HPV vaccine are not more likely to have sex. 

About the Source 

Jason Terk, M.D., earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

While the increase in self-injuries may not seem that extreme, Lisa Elliott, Ph.D., a licensed psychologist and clinic manager of Behavioral Health for Cook Children’s in Denton, said the study does not tell the entire story. Sometimes the degree of cutting, for example, may not be severe enough to receive medical attention.

Elliott presents to schools, churches and community organizations on the issue of teens and self-harm injuries. She also treats patients in her practice.

“It can be difficult to determine the prevalence of these types of injuries accurately due to the secretive nature of self-harm prevalence,” Elliott said.

Elliott says that the most accurate numbers show that 20 to 23 percent of teens engage in some type of self-injury. The age of self-harm abuse typically begins between the ages of 12 to 14 years old.

Research shows that gender differences appear only to be associated with method of self-injury. Females are more likely to use cutting. Both genders use burning and self-battery. Caucasians are significantly more likely to engage in self-injury than non-Caucasians.

Methods of self-harm include:

• Cutting (70 percent of self-injuries)
• Carving
• Scratching/biting
• Burning/abrasions/branding
• Hitting themselves
• Picking/pulling skin and hair
• Head banging
• Tattooing
• Excessive body piercing

Injuries are most commonly found on arms, hands, wrists, thighs and stomach.

"This is something we see quite often, mainly in female teenagers, and it has increased dramatically in the last several years once it became a 'thing' that teenagers do and have seen or heard about," said Corwin Warmink, assistant medical director in the Emergency Department at Cook Children's. "It is a response to stress and anxiety and gives the performer a sense of control and eases their anxiety. It is not a suicidal behavior, but some studies have shown people who perform self-injury are more likely to commit suicide than people who do not. It also can be indicative of a more serious mental disorder."

So why do kids harm themselves?

“Kids who repeat self-harm injuries are often trying to ease some type of intense, overwhelming negative emotion such as anger, pain, anxiety or frustration,” Elliott said. “That’s the most common reason, but the second most common reason is self-punishment. They are expressing anger at themselves. This is strongly connected to self-derogation and criticism.”

Other reasons for self-harm include:

• Interpersonal influence – as a means to garner affection/caring from others, to identify/connect with others who have self-injured, to “belong” or fit in with a peer group.
• Stress management.
• To feel a sense of control over their own body, feelings or life situations.
• To provide a distraction from painful emotions through physical pain.

Kids who engage in self-harm behavior are more likely to tell and seek help from a peer their own age than tell a parent. Usually, adults only become involved if that peer tells a grownup and asks for help for his or her friend. Other times, a teacher or coach hears talk among other teens and steps in to help.

Elliott offers these tips to identify if your child is involved in self-harming behavior:

• Dressing in long sleeve shirts/hoodies even in hot weather.
• Wearing concealing outfits.
• Avoiding activities such as sports and swimming.
• Making excuses for having cuts, marks, wounds on body.
• Finding razors, scissors, lighters, knives in unusual places such as under the bed.
• Spending long periods of time locked up in bedroom or bathroom.

For more information

To schedule an appointment or refer a patient to Behavioral Health Services, please call 682-885-3917. To have Lisa Elliott speak more on this topic at your school, church or community organization, click here.

Richard Roberts, M.D., a neurosurgeon at Cook Children’s, wonders what it’s worth for your child to play sports with a reputation for head trauma.

“I think the fact that when the NFL players sued the league initially and won, the judge said the settlement (more than $700 million) wasn’t big enough,” Dr. Roberts said. “That says a lot about this growing issue more so than anything else.”

The issue discussed in the NFL cases has been CTE (chronic traumatic encephalopathy), a progressive, degenerative brain disease that has been found in some athletes with repetitive brain trauma.

Research is currently being done to study just how playing contact sports such as football mainly, but also soccer, can cause damage to an athlete’s head. But is it worth it for parents to wait for the results of this work.

“Amateur sports are different than professional sports because no one is feeding their family with the activity that they are doing,” Dr. Roberts said. We need to look beyond the short term and really understand what could happen in the long term. That potential for long term problems should be the primary thought, not the secondary thought.

“What is the actual incidence? We don’t know. But if it was your kid, how much would you be willing to risk? Even if it was 1 in 10, would you roll the dice on your own kid?”

Dr. Roberts has previously worked at Children’s Hospital in Philadelphia and Charity Hospital in New Orleans. While he saw concussions at the other hospitals, he’s never seen parents argue with him about concussions as he has seen at Cook Children’s.

“Part of what I’ve seen which is different here than other places is that I do get push back from parents who I think underestimate the severity of some of these injuries,” Dr. Roberts said. “Some of it is that they want their kids to play and I think some of it is the short term nature of some concussions.”

Children get concussions and they do well relatively quick, so opposed to having a broken arm which is in a cast or needing surgery and having stitches for three weeks, kids hurt their heads, they are knocked unconscious for five minutes, but then feel essentially better soon after. This apparent sign of improvement makes it difficult for some parents to grasp that their child may have a fairly significant brain injury.

“The more we understand concussions and the more we see people who have hurt their heads for various reasons, soldiers, professional athletes, anyone who has suffered a head injury, I think that we are seeing that in adulthood they are starting to have more cognitive issues,” Dr. Roberts said. “Now the science is not perfect yet. We can’t say to a football player you had three concussions and that’s why you have dementia. We can’t say to the soldier you were exposed to be a bomb blast and that’s why you have dementia because it could be multifactorial. It could be that you have the right genes to make you this way later on. But the percentage seems higher in people who have had traumatic brain injuries.”

Dr. Roberts says parents should be concerned after head injury one. He knows you have to let kids live their lives and be kids, but the brain wasn’t made to get beat up like happens sometimes in sports.

It’s not known for sure that after one concussion, people are more likely to get more, but Dr. Roberts’ suspicion is that it is likely the case.

And when does he have a serious heart-to-heart with the parents and the athlete?

“After two. We discuss no longer participating in the activities which could cause further injury because the likelihood of you having a head injury in your lifetime is still pretty high,” Dr. Robert said. “You are going to hit your head on a tree branch or you are going to fall off your bicycle or someone is going to run into you. You are going to be stepping out of the car and slip or walking across ice and fall down. My opinion after behavior has shown us that you are going to get injuries in a particular sport, you should probably not be playing in that sport because you are not able to protect your head.”

Dr. Roberts has seen strong reactions from both the parents and the kids after being told he or she should quit playing their respective sport. And it’s not just football as most people expect. It’s with the gymnast who has fallen off the bars and knocked herself out or the soccer player who has headed the ball and gotten knocked unconscious.

But football still remains king in Texas – in popularity and in concussions.

So what can be done about it?

Dr. Roberts is not sure there’s a good answer to that question. Building better equipment helps, but then armoring players probably makes them feel invincible and they hit harder. If you take away the facemasks or hard shell football helmets, he expects you will return to the old days – less concussions, but more skull fractures and in the process, immediate deaths on the playing field.

For now, Dr. Roberts wants parents to monitor their kids closely and to take the recommendations from their doctor closely. If they say it’s time to stop – stop!

“All the steps that sports are taking to make it safer are positive,” he said. “I think that everybody involved has to think less about return to play and more about long term health.”

About the source

Richard Roberts, M.D., is a neurosurgeon at Cook Children's. When a child with a neurological disorder requires surgery, the experts at Cook Children's Medical Center offer comprehensive care and state-of-the-art technology. With the help of such state-of-the-art equipment as the revolutionary intraoperative MRI (iMRI), our neurosurgeons are able to determine effectiveness of surgical procedures for cranial and spinal nerve disorders and tailor the treatment to each child's unique needs.

When my son Jack was born via C-section, everyone had something nice to say about his beautiful round head. “It’s so perfect! Not like the poor little cone-headed babies!” Little did they know that his pretty little spherical skull would soon resemble a pancake on one side.

Does your baby’s head have a flat spot? A flat region?  A flat continent?  Do not fear!  It’s likely normal skull flattening (the fancy medical term is positional plagiocephaly), it’s totally normal, and only rarely do baby craniums need any “fixing.”

Let’s talk about infant skulls – like many baby body parts, they aren’t small versions of the adult skull. They are unique and functional. They are made of bone plates that are loosely held together, and they can move and shift. This special ability helps the baby with an easy exit through the birth canal, and allows the brain to rapidly grow during the first year of life.

However, after that exit, there are lots of external forces that can flatten the infant skull. Often, it’s due to your pediatrician’s golden rule of putting her on her back to sleep. In 1992 we launched this campaign to reduce the rate of SIDS, or Sudden Infant Death Syndrome. What came next was a beautiful drop in the number of babies dying in their sleep, and the unfortunate side effect was the rise of plagiocephaly. 

So your baby is a few months old now, you’ve been putting her on her back to sleep like your pediatrician recommended, and now she’s got a big ole flat spot on the back of her head. What can you do to make it better?

• Give her plenty of supervised tummy time while she’s awake. Find new toys or objects to stimulate her everyday. A mirror is very entertaining! Prop her up on a pillow to give her a little height (And her heavy head a soft landing pad). I find the breastfeeding pillows have the perfect curve for it. 
• Hold your baby while she’s awake to relieve pressure from carriers, swings and infant seats.
• Alternating things in the room to encourage laying on the other side of the head. I found that putting a bright light-up toy, or a mirror, or even myself on a certain side would encourage Jack to look that direction and relieve the pressure on the flat spot. This also works during naps/sleep time – if your baby likes looking out the slats of the crib, flip her head/feet orientation in the crib so that she has to turn her head a different direction.
• There are many commercial items that claim to “round out baby’s head,” with new things coming out everyday. Research these products carefully and bring it up with your pediatrician before making the purchase, to assure they are safe.

When is a funny-shaped head a true medical problem?  If you have concerns about your baby's head shape, always feel free to talk with your pediatrician about it. Pediatricians typically evaluate the shape of an infant's head during the physical exam at the many checkups they gets during her first year. Usually positioning changes (like the ones listed above) can fix a flat head over time, but sometimes a helmet can be used in severe cases to help it along. In rare cases, we advise that a specialist be seen, like a physical therapist or a neurosurgeon.

Rare instances include:

• The flattening has led to facial changes, like a protruding portion of the forehead, and/or one ear that sits asymmetrically to the other.
• A misshapen head that is due to the skull's bone sutures closing too early (called craniosynostosis - your pediatrician is trained to notice signs of this)
• If you notice that your baby has problems with or may even be unable to turn her head to one side, leading to skull flattening, it may be due to a tight neck muscle - a condition called torticollis.

So my point – and I do have one - is that I’ve seen many funny-shaped heads in my office (and witnessed the evolution of a pretty darn cute one at home), and the vast majority fix themselves over time. Always talk with your pediatrician if you’re worried. That’s what we’re here for!

And as for Baby Jack, he did lots of tummy time to help get rid of those flat spots!