Childrens Seizure Pathway

A seizure is a sudden episode of transient neurological symptoms such as involuntary muscle movements, sensory disturbances
and altered consciousness (The American Heritage Science Dictionary).

MANAGEMENT OF SEIZURE IN AN OUT OF HOSPITAL SETTING

Known Epilepsy
No

Yes

Fever

No Fever

Seizure
>5mins

Call 999

Transfer to
A&E
Criteria for
admission
(see box 1)
Also review
sepsis and
fever
pathway.

Seizure
>5mins

Seizure
<5mins

Seizure
>5mins

Seizure
<5mins

Referral
criteria
(see box 1)
Consider
fever
pathway

Call 999
Give rescue
Medication
(see Box 2)

Full
recovery?

Meets
criteria?

Yes

No

Transfer to Paed
unit/PAU
Home with
febrile seizure
advice

Yes
A&E
Follow
status
pathway

Referral
criteria
(see box 1)
Meets
criteria?

Transfer once
stabilised to
Paediatric
Unit

Yes

Seizure
<5mins

Is rescue
medication
available?
Yes

No
A&E
Consider
Investigations &
discuss with Paed
Reg on bleep 733

No

Contact Epilepsy
Nurse Specialist for
advice (in hours) tel
01582 557055
See GP in next 24hrs

No

Administer rescue
medication
(See Emergency
Plan in pink folder
& Box 2)
Does seizure
continue?
Yes
Call 999
Transfer to A&E
Status Pathway
Look for childs Emergency
Plan in A&E
Contact Paed Reg-bleep 733

Call 999

No

Stay at home
Notify:
Paediatrician/
Epilepsy Nurse
Specialist

Childrens Seizure Pathway

A seizure is a sudden episode of transient neurological symptoms such as involuntary muscle movements, sensory disturbances
and altered consciousness (The American Heritage Science Dictionary).

Obtain blood glucose level at time of seizure or as soon after as possible.

In the hospital setting an ECG should be performed for convulsive non-febrile seizures.

Box 1

Box 2

Criteria for referral/admission

Rescue Medication (as per Emergency Plan or Status Pathway)

I
I
I
I
I
I
I
I
I
I
I
I
I

Prolonged seizure
Recurrent seizure on same day
No focus of infection on examination for febrile seizures
Evidence of intracranial pressure (blurred vision, bulging fontanelle
in infant, persistent headache associated with vomiting).
Focal neurological signs (one sided weakness, squint or paraesthesia)
Drowsy or GCS<15 1 hour post seizure
Signs of sepsis/meningitis (see fever pathway)
Age < 18 months for febrile seizure
Age<2 years for non-febrile seizure
Consider parental anxiety / social circumstances.
Seizure after a head injury (refer to head injury pathway)
Focal seizures
NICE guidelines advise that immediate referral and investigations are not
required for a child over 2 years of age that has had a non febrile
generalised tonic/clonic seizure and made a full recovery
Second non-febrile seizure with full recovery refer to paediatric outpatients

Buccal Midazolam
1-6 months 300 micrograms/kg (max 2.5mg)
6 months to 1 year 2.5mg
1-5 years 5mg
5-10 years 7.5mg
10-18 years 10mg

Rectal Diazepam
1-12 months 2.5mg
1-5 years 5mg
5-10 years 10mg
10-15 years 15mg
Over 15 years 20mg

Rectal Paraldehyde
Dosage as per Emergency Plan
Second dose of midazolam or diazepam can be given if child
continues to seizure 10 minutes after first dose but in presence
of paramedics.

This guidance is written in the following context

This assessment tool was arrived at after careful consideration of the evidence available including but not exclusively NICE Guidelines, EPEN and NHS evidence. Healthcare professionals
are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to
make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.