These include:

• placing them on the floor so they do not fall and hurt themselves
• putting them onto their side so they can breathe easier
• clearing the area of hard or sharp objects
• placing something soft and flat under their head
• removing their glasses
• loosening or removing anything around their neck, such as a tie or a necklace

Start the following for convulsion management:

Age > 1 month.

Child convulsing Ensure safety and check ABCD

A – Place in lateral position, suction if indicated

B – Start on oxygen via NRM

C – Check for temp gradient, severe pallor

D – Check RBS or give 5mls/kg of 10% Dextrose

Steps in care:

Convulsion lasting > 5min?

• Give IV Diazepam 0.3mg/kg slowly over 1minute OR rectal diazepam 0.5mg/kg

Alternatives include IV Lorazepam or buccal midazolam(dosages in the formulary)

• Check ABCD when convulsion stops, observe and investigate cause / refer appropriately

Child having 3rd convulsion lasting <5 mins in <2 hrs (short multiple convulsions).

If children have up to 2 fits lasting <5mins, they DO NOT require emergency drug treatment

Convulsion continues 5mins after first dose of diazepam

• Give the second dose of IV diazepam 0.3 mg/kg slowly over 1minute, OR rectal diazepam 0.5mg/kg
• Continue oxygen
• Check airway and breathing when convulsion stops, investigate & treat cause / refer appropriately
• Give IM phenobarbitone 15mg/kg (loading dose)
• Initiate maintenance therapy with phenobarbitone 2.5 mg/kg OD for 48 hrs then review
• Continue oxygen during active seizure
• Check ABC when convulsion stops, investigate and treat cause / refer appropriately
• DO NOT give more than 2 doses of diazepam in 24hrs once phenobarbitone is used
• DO NOT give a phenobarbitone-loading dose to an epileptic on maintenance phenobarbitone
• Phenytoin, levetiracetam and IV sodium valproate (see doses in the formulary) are alternatives to phenobarbitone