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Dear colleges
I red the comments on this subject with interest, because we have the same
discussions at our hospital. Guidelines as the ones from AAP are good,
especially if you are inexperienced in handling with kids. Following our
own recommendations, we would also perform a LP in a child under 12months
with a febrile seizure. But I think, this rule or others mentioned like
"any febrile child with a first seizure gets a tap", are to strict. We
should always remember, that we don't just handle with "febrile seizures"
but with "kids". And the more experienced somebody is, the more he should
be able to take individual decisions and  trust clinical features. So why
should I perform a LP on a 7 months old child after a febrile seizure, with
a history of gastrointestinal infection (most probable reason for the
fever), sitting on her mothers knee in the ED and smiling at me?
Sergio Stocker, MD
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Children's Hospital
Zurich, Switzerland
 
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