If the child is in a sitting, standing or walking position when you observe the seizure, help him to lie down, so that he will not fall and get hurt. If at all possible, place the child on a blanket or protected surface. Turn your child on his side so the saliva can flow out of his mouth. Do not put anything in the child’s mouth. It used to be the practice to put a tongue depressor into the mouth and hold the tongue down. This is no longer done and can, in fact, be harmful. The child may clamp down hard with the teeth during the seizure and break either the tongue depressor or a tooth and choke on a piece.

Also remember that it is usual for a child’s breathing to become irregular, so don’t be alarmed. .

Move all sharp objects out of the way, as well as any furniture. Pad any sharp objects that cannot be moved, to prevent the child from getting hurt. If the child is wearing restrictive clothing, loosen it, especially in the chest and abdominal area.

Do not interfere with the seizure or try to stop it. Allow the seizure to continue without interruption. Check the child's breathing. If the child has stopped breathing, clear the airway and perform mouth-to-mouth breathing.

Call 911 or call for other emergency medical assistance if the following conditions occur:

• Color change during seizure
• Breathing problems during the seizure
• A prolonged seizure lasting longer than 10 to 15 minutes
• Repetitive seizures without recovery between seizures

If it is not your child’s first seizure, it is usually not necessary to call a doctor right away. You should, however, seek emergency care immediately if your child’s seizure is very active for more than ten to fifteen minutes.

Being able to describe the seizure for the doctor is very important, because it helps the doctor determine the diagnosis and management of the child’s seizures. If you observe a seizure, take note of the following:

What was occurring just before the seizure? (If the child can not talk, some of this information will be difficult to ascertain.)

Was there an aura?  An aura is any strange or unusual feeling, taste, sound (humming, ringing, etc.), or visual changes.

Did something trigger the seizure?  Some triggers are illness, stress, body changes (adolescence), hyperventilation, and flashing lights.

What was occurring during the seizure?

When did it begin, and how long did it last?

Which body parts were affected?

What was the form of the movement (stiffening, jerking, shaking, twitching, etc.)?

Were there any eye movements (staring, eyelid fluttering, eyes looking in a particular direction, etc.)?

Was there loss of control of bladder or bowels?

Was there loss of consciousness or any type of confusion?

What was the general appearance?

What was occurring after the seizure? 

• Was there confusion or disorientation?
• Was there fatigue or sleepiness?
• Was there headache?
• Was there an injury?

It cannot be emphasized too strongly how important it is to remain calm during a seizure.  By being calm, the caregiver will be able to help children during the seizure or will be able to get medical assistance if necessary.

If it is suspected that children are having seizures, the doctor is likely to recommend an electroencephalograph (EEG–a graphical record of electrical activity of the brain).  If the EEG confirms the suspicion, the neurologist will discuss possible treatments.  Usually, anticonvulsant medication is recommended.  It can reduce or eliminate seizures in about 90 percent of children with epilepsy.  Medication might not be necessary if children have febrile seizures (seizures brought on by fevers over 102º), infrequent seizures, or minimal seizures (such as brief staring spells occurring only every several weeks).

The type of medication prescribed for children depends on the type of seizure.  For tonic-clonic seizures, phenobarbital and phenytoin (Dilantin TM) are most often used.  Carbamazepine (Tegretol TM) is frequently used for psychomotor seizures.  Valproic acid (Depakene TM) helps control myoclonic, absence, and tonic-clonic seizures.  Other medications that might be used include clonazepam (Klonipin TM), primidone (Mysoline TM), diazepam (Valium TM), and ethosuximide (Zarontin TM).  These medications may be used alone or in combination.

Of course, no matter what medicine doctors prescribe, they must carefully calculate the most appropriate dosage for the child’s age and weight.  Because few clinical trials have tested seizure medicines in children, doctors must use their experience with their young patients and information from trials that tested seizure medicines in adults.  Dosages for children are usually expressed as a certain number of milligrams per kilogram per day (mg/kg/day).  The "kg" refers to the child’s  weight in kilograms.  One kilogram is about 2.2 pounds, so a 22-pound toddler weighs 10 kilograms and will get 100 mg of medicine each day if the recommended dosage is 10 mg/kg/day.

Parents often worry that medication is too strong or too weak, because the number of milligrams in each pill is quite different from the number in another kind of pill.  Doctors know that the effective dose of different medicines varies widely.  For instance, the usual dose of Trileptal (oxcarbazepine) for a 10-kilogram toddler is 150 mg per day (15 mg/kg/day).  But if the doctor prescribed Lamictal (lamotrigine) for the same child, the dose would probably be only 50 mg per day (5 mg/kg/day).  The difference in dosage doesn't mean a difference in effectiveness. The two medications are just different.  Concerns about the dosage of a child's medication should be discussed with the doctor.

Doctors can get information about dosages for children from medical journals that report on the use of the medicine by children.  Not all of the studies reported fit the requirements that would be needed for the Federal Drug Administration (FDA) to approve the use of that medicine for that particular disorder in children, but they all add some information to the doctor's pool of knowledge.  The FDA recently began allowing drug manufacturers to distribute some of these articles to doctors, which should help to increase their knowledge about off-label uses and dosage.

Sometimes doctors want to perform tests to measure the amount of medication in the blood.  The result is called a "blood level" or "drug level."  There is no "right" blood level for all children.  Occasionally, the level may help the doctor to tell how a child’s body is using the drug.  The information may warn the doctor and parents to be on the lookout for seizures, troublesome side effects, or poor adherence to the schedule of taking the medicine.  Most of the time, however, there is no need to measure the blood level.  If the child is having frequent seizures and no side effects, the doctor does not need a blood level to know that the dosage should be increased.  Similarly, if the child is having trouble with side effects, the dosage should be lowered.  Measuring the blood level of medication is very rarely necessary in managing children's epilepsy.

Although medications are very effective in preventing or reducing seizures when given regularly, they may also produce a variety of side effects.  For example, they may cause hyperactivity behavior, irritability, sleep problems, growth of body hair, lethargy, depression, or sedation.  They may affect liver function or blood counts.  Because of these possible side effects, the pediatrician and neurologist must monitor children closely when they are on medication.  Through periodic blood tests, they will determine the children’s therapeutic level–the amount of drug in the blood which usually controls seizures with a minimum of side effects.

Sometimes medications cannot control children's seizures.  In some cases, the parents are concerned about the side effects their children are experiencing from medications.  They may want to try other ways to control the seizures.  Another way to control seizures that works for some is the Ketogenic Diet, a very strict diet that is high in fat and low in protein and carbohydrates.  The Ketogenic Diet has been around almost as long as cerebral palsy has been recognized.  The diet is being looked at again as a way to control seizures.  It is being very successful in some cases.  If this approach is considered, the neurologist will refer the parents to a nutritionist.  (It is not the same as popular, low-carbohydrate diets, such as the Atkins Diet.)

The name ketogenic means that it produces ketones in the body (keto = ketone, genic = producing).  Ketones are formed when the body uses fat for its source of energy.  The body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead.  Ketones are not dangerous.  The diet alters the body’s metabolism so that the amount of ketone bodies–compounds normally excreted in the body’s fluids–are greatly increased.  The resulting metabolic state can help control seizures.  The diet works best for children under the age of five whose nutrition can be closely monitored.