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Case
#54 "Shaking With the Pink Stuff…"
by Charlene Babcock Irvin, MD
 An
18 month female is brought in for ‘shaking’
at home. Grandma is babysitting the child
for a few days, and notes that the baby was
taking a nap in front of the TV, seemed to
be waking up (moving around a little) then
started shaking like she was having a
seizure. Grandma knows what a seizure is
because she has a daughter with epilepsy.
This is the second seizure for this baby,
because the mom told the grandma before she
left that the baby had a fever seizure three
days ago when they diagnosed the ear
infection. The seizure today lasted about
3-4 minutes, and then the baby was sleeping
for about 10 minutes. Now the baby is back
to normal (it has been 45 minutes since the
seizure).
PMH: Full term baby, shots up to date (she
thinks). No hospitalizations or surgeries.
She did have the fever seizure three days
ago. No previous history of seizures. Aunt
has epilepsy, but no other family history of
seizures.
Meds: She is currently on ‘the pink stuff’
for an ear infection that was diagnosed
three days ago.
ROS: She has had some fevers on and off for
the past three days. No coughing, no rashes,
no obvious pain, no problems urinating.
Bowels have been looser than usual, but
grandma thought that was from the
antibiotic. No blood in the urine or stool.
Baby has been acting normal after Tylenol
for the fever, but is acting tired when the
fever is up. She does have a decreased
appetite for food, but is drinking normally
and has a normal amount of wet diapers.
PE: Temp 102.5 F rectal, HR=160, RR=28
(these are the triage vitals, child received
Tylenol at triage).General appearance: Comfortable 18 month
old, sitting on grandma’s lap, with good eye
contact in no distress. She will not smile,
but is consoled by grandma.
HEENT: PERRL, TM--left erythematous with no
movement to insufflation. Neck supple. MMM,
Anterior fontanel almost closed and normal.
HEART: RRR no murmurs
Lungs: Clear, unremarkable
Abd: Soft nontender, no masses
Ext: Normal
Skin: No rashes
Neurologic: Normal
1. Can you treat this child without a note
from the mother? Grandma doesn’t have a note
allowing her to seek treatment on behalf of
the mother.
2. What about a teenager presenting for a
possible sexually transmitted disease
without consent or knowledge of their
parents….do you treat them? Do you tell the
parents?
3. When do the fontanels close?
4. Is this a simple or complex febrile
seizure? Does this child need a spinal tap?
Click here for answers and to respond
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