In this section
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
See also: Febrile Convulsions guideline, Coma guideline
Most convulsions are brief and self limiting, generally ceasing within 5 - 10 minutes. These seizures do not need immediate management unless they continue beyond this timeframe.
Seizures should be treated immediately in the following situations:
- Child presents actively fitting (cause and duration unknown)- Known cause warranting more urgent treatment
Assessment and management need to occur concurrently if the child is actively convulsing.
Key considerations in assessment include:
Note:It is now recognised that some children can have a presentation with convulsions and an acute infectious illness (particularly gastroenteritis) without documented fever. This is sometimes referred to as " afebrile febrile convulsions". The management and prognosis is the same as for classical febrile convulsions.
In most situations (see above) supportive care for 5 - 10 minutes is appropriate. Ensure adequate airway and breathing while waiting for convulsion to stop spontaneously.
If seizure persists or the onset has not been witnessed, pursue active management (see management algorithm and drug dose table). Include benzodiazepines given on the way to hospital (eg by parents or paramedics) when using this algorithm.
Table of Medications see drug doses:
0.1-0.3 mg/kg0.3-0.5 mg/kg (max 10mg)
Ensure all children have their BSL checked and corrected. See hypoglycaemia guideline.
Consider checking electrolytes if this has not been done previously. In particular, consider hypocalcaemia in dark-skinned children.
- Child requiring care beyond the comfort level of the hospital.
For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
All other children with a first afebrile seizure who have fully recovered should be referred to the local paediatric team for follow up.
Information Specific for RCH
Children with afebrile seizures are normally admitted under general paediatrics, unless known to another team.
Other Epilepsy Resources
This includes links to many drugs, the use of rectal and oral diazepam, and buccal midazolam.
Last updated September 2011