On several occasions in paediatric practice we come across unusual mannerisms, perceptions, and behavior in infants, children, and teenagers, causing considerable concern. Many are dramatic, uncharacteristic, or repeated and finding an explanation can be difficult. Young children take to head banging, head rolling, body rocking, bed wetting nightmares, or grinding their teeth. Adolescence brings on obsessions, compulsions, and self-injurious or self-stimulating behavior. Medical evaluation hopes to make or refute a proposed diagnosis of seizures (or fits) and to provide treatment or reassurance as necessary.

Fits have several subtle and confounding atypical manifestations and many conditions mimic a fit. This is one area wherein pediatricians wait before putting a label on the child and are used to not having all the answers. Some events cannot be classified and we wait after a full assessment is performed and follow up the child till the benign nature of the events is apparent. And then we agree on channels for parents to seek reassessment if the situation changes. During this time, the parents are asked to keep a careful record of the circumstances of their attacks and eye-witness descriptions.

One common condition causing alarm is fainting (technically called the syncope).This is caused by a sudden reduction in blood flow to the brain, or from a drop in its oxygen content (or a combination of the two). Specific immediate triggers for fainting are a minor injury, procedures like immunisation or blood tests (or even seeing blood), standing still or standing from sitting after a long time, sudden surprises/shocks, exercise, etc. Premonitory symptoms include light-headedness, feeling hot and sweaty, nausea and not uncommonly, visual disturbance. When loss of consciousness occurs, there may be associated loss of muscle tone often with a relatively gradual rather than an abrupt onset (‘swoon’) but many will have anoxic fits with stiffening and jerking of the body. This does not qualify as a seizure disorder and is usually not treated. However a tongue bite, passing of urine or stools in unawareness or a prolonged confusion after recovery is suggestive of a fit and will require more investigations.

What is important is to remember that fainting can be a symptom of abnormal heart function (disturbances in rhythm or musculature) which could cause sudden death if not treated. Therefore all children with recurrent or unexplained fainting should have a standard cardiac evaluation (especially if  there are reports of sudden deaths in young adults in the family).

Some other conditions that you may come across:

• Sleep disorders are unusual behavioural and/or physiological events that limit sleep, interfere with certain stages of sleep or disrupt the sleep-wake transition , and may resemble fits. Narcolepsy is a condition where the affected child is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime sleep attacks may occur with or without warning and may be irresistible.
• Pseudo seizure is the term given to illness behaviour presenting as a fit and indicates significant psychological disturbance and is a challenge to treat. Goal-directed behaviours, expressions of anger or violence, or uncoordinated flailing movements of the extremities are likely signs of pseudo seizures and injuries rarely occur in the episodes.
• Children who daydream are sometimes referred to the doctor because of concern that they may have childhood absence epilepsy. This is a condition in which the child has fits occurring as staring spells during which he or she is not aware or responsive. An EEG test is often needed to make a diagnosis.
• It is not unusual for children to present with migraine headaches associated with dizziness, nausea, abnormal sensations and visual disturbance. They can be treated with medication.
• Children can experience what is called vertigo or giddiness, which is described as a sensation of whirling and loss of balance, associated particularly with looking down from a great height. This is caused by disease affecting the inner ear or the stimulating nerve and can be treated.

Fits, faints and funny turns remain memorable accounts in a physician’s drama and many episodes lead to insightful learning!

Re-published with permission from the blog of ParentEdge, a bi-monthly parenting magazine that aims to expose parents to global trends in learning and partner with them in the intellectual enrichment of their children. This blog was written byDr. Krishna Mahathi

Dr. Krishna Mahathi holds diplomas in Pediatrics and in the management of allergies and asthma. Years of working and interacting with children and parents have given her insight into developmental disabilities. She wishes that there was more awareness and acceptance of the issues that differently-abled children face and hopes that through this blog, she can enable thse children and their families to make sensible and informed choices.