What to do in case of a seizure

Some seizures only involve short periods of unresponsiveness and do not require specific interventions. Other types of seizures are more intense and require specific interventions, such as ensuring the child maintains a clear airway to allow air into the lungs.

It is important for you, your family members, teachers, babysitters and anyone else who looks after your child to know what to do when your child has a seizure. The most important things to do in response to any type of seizure are to remain calm and to keep your child safe. No matter what the seizure type, if your child seems to be having prolonged seizures, many seizures in a short period of time (clusters of seizures), or many more seizures than usual, seek medical attention.

The following are general suggestions for how to help your child when they are having a seizure. You may find that some tips work better than others, or that your child needs one particular type of help during a seizure. You may already know or will come to know what works best for your child. Let other people know as well.

For information on what to do for specific types of seizures, please see the following pages:

• Absence seizures
• Tonic, clonic and tonic-clonic seizures
• Myoclonic seizures
• Atonic seizures
• Simple partial seizures
• Complex partial seizures
• Status epilepticus
• Neonatal seizures
• Febrile seizures
• Pyridoxine-dependent seizures

What to do if someone has a seizure

Step 1: Stay calm and reassure others

Many people are scared when they see someone having a seizure. You can help your child by staying calm. Reassure them and others around you that everything is under control.

Step 2: Prevent injury

• Keep your child away from sources of danger. If they are near a stairway, a hot stove, a busy street, or other hazards, protect them as much as possible.
• Remove nearby objects that are sharp or hard. Try to put something soft like a folded jacket under their head.
• Do not hold them down or try to stop their movements, as this might result in injury.

Step 3: Be aware of the length of the seizure

If possible, note the time that the seizure begins, and how long it lasts. If it is the child’s first seizure, or their first convulsive seizure, or if the seizure lasts more than five minutes, call 911 or emergency services. Pay attention to the nature and the length of the seizure so you can give an accurate report.

Step 4: Make your child as comfortable as possible

• Remove glasses so they do not break.
• If your child has food in their mouth, do not attempt to take the food out as this may actually push it farther in.
• If possible, roll them gently onto their side, or roll their head and if possible, their upper body to the side so that any fluids can drain out of their mouth. You may need to wait until they have stopped shaking.
• Loosen anything around their neck to make breathing easier. Loosen buttons or belts that are tight.

Step 5: Do not put anything in your child’s mouth

Putting a finger, a spoon, a pencil, or any other object in their mouth could result in choking or broken teeth, not to mention a bitten finger. It is a common misconception that people can swallow their tongue during a seizure. This is not true because the tongue is attached to the base of the mouth.

Step 6: Keep bystanders away

Only one or two people are needed for first aid. Your child may feel upset and embarrassed when they become conscious if many people have been watching.

Step 7: Do not give your child any water, food, or pills until the seizure is over and they are fully alert

This will prevent choking. In some cases, your child’s doctor may have prescribed medication to be used at the time of the seizure; use it as directed. An easy way to check if they are alert is by asking simple questions until your child has returned to their usual state.

Step 8: Be sensitive and supportive after the seizure

Children usually recover from seizures on their own.

• If your child is old enough, explain to them exactly what happened, and how long the seizure lasted.
• Your child may want to be comforted. Help to reorient them by telling them where they are and describing to them what has happened.
• They may have wet their pants or had a bowel movement during a seizure. Providing dry undergarments as soon as possible after the seizure will help them to feel more comfortable and may lessen any feelings of embarrassment. Tell them you know that they could not help it.

Step 9: After the seizure

• If your child complains of minor pain from a headache, muscle ache, or bitten tongue, acetaminophen may help.
• If they have severe pain, or if they were injured during the seizure, take them to see a doctor.
• If your child has a fever associated with the seizure, consult your child’s doctor. They may have an infection that needs to be treated.

Oxygen

In many cases, a child who is having a seizure will be given oxygen by emergency services. However, the benefits of this have not been studied. In most cases, it is not necessary to give a child oxygen during a brief seizure, however there is no harm caused to a child if they do receive oxygen.

Seizures in water

If your child has a seizure in the water:

• Support them and keep their head above water
• Get them out of the water as soon as possible
• Check to see if they are breathing and if not, begin CPR
• Always have them checked by a doctor as soon as possible, even if they seem to be fine, in case they have breathed in some water that might contain harmful bacteria

You cannot always be there while your child is having a seizure. Make sure friends, family, babysitters, teachers and other caregivers also know how to help them if necessary.

Taking notes and videos

For all seizures, especially the first few seizures your child experiences, try to observe as much as possible about the seizure and record it as needed. This will help your child’s doctor understand more about their epilepsy. You may also choose to record video of a seizure to help your doctor see what these events look like.

Information you can observe includes:

• The time of day the seizure occurred
• What your child was doing before the seizure
• If your child was sick, tired or stressed
• If your child is taking their seizure medication as prescribed
• If they are taking any other medication
• How the seizure began
• If they described feeling any warning symptoms before the seizure
• What their movements (if any) looked like during the seizure: did their head turn and, if so, in which direction or did an arm or leg shake?
• If the movements occurred on a particular side of their body
• Whether they were able to talk and respond during the seizure
• Whether they made any sounds
• The length of the seizure
• If they were confused, tired or sore after the seizure
• If they vomited or lost control of their bowel or bladder
• If they could speak and move their body normally after the seizure
• If anything about this seizure was different from their other seizures

What to do in emergencies

In some cases, a child can experience status epilepticus, which is a medical emergency. This includes seizures that last a long time (more than 30 minutes) or seizures that occur one after the other without time to recover in between. Status epilepticus should be stopped as soon as possible. The longer a seizure continues, the more difficult it becomes to stop the seizures with emergency anti-seizure medications.

When to call 911 or emergency services

Call 911 or emergency services if:

• this is your child’s first seizure
• a seizure lasts a long time (usually 5 minutes or more)
• you have given an emergency anti-seizure medication such as lorazepam, diazepam or midazolam after a seizure persists for 5 minutes and the seizure continues for more than a few minutes afterwards
• your child has several seizures without time to recover between them
• your child does not regain consciousness after a seizure
• you think your child may have been injured during the seizure

The longer a seizure continues, the more difficult it will be to stop. However, every child is different, and every child’s epilepsy is individual. For example, if your child usually has seizures that last 7 minutes, you and your child’s neurologist may decide that you can wait longer before calling an ambulance. If you are in a more remote area, make sure you know how long it will take to get your child to a hospital, and calculate accordingly. Depending on where you live, it may be important to have a letter from your doctor on how to manage your child’s epilepsy. However, all doctors that work in emergency departments are trained in how to stop seizures. Make sure that people who look after your child also know what to do if your child has a seizure.

When to call your child's health-care team

Call your child's doctor if:

• your child has seizures more often than usual
• your child has a different type of seizure than usual
• your child is ill
• you notice anything else different about your child’s seizures

Keep your child’s doctor informed about your child’s seizures at each check-up. You may find it helpful to keep a written or electronic diary of your observations, including the date and time of the seizure; what your child was doing when the seizure happened; and what the seizure looked like.