General Approach to All Pediatric Patients

Seizures - Pediatric

Basic Life Support

  • Supplemental 100% oxygen if active seizures
  • Blood glucose check

Advanced Life Support

  • Full Pediatric ALS Assessment and Treatment
  • Determine blood glucose and treat if glucose < 70 mg/dl
    • D10W at 5 ml/kg for children < 1 year old (max 40 ml)
    • D25W at 2 ml/kg for children 1-8 years old (max 50 ml)
    • D50W at 1 ml/kg for children ≥ 9 years old (max 50 ml)
    • If no IV available:
      • Glucagon 0.1 mg/kg IM (Max. 1mg)
    • If hypoglycemia persists:
      • Repeat blood glucose check with a different glucometer
      • Repeat Dextrose (as above) once if blood glucose < 70 mg/dl after 10 minutes
  • For active seizures only, choose one of the following options:
    • Do NOT delay treatment to obtain intravenous access, begin with IM dose unless IV is already established
    • Midazolam (Versed) 0.2 mg/kg (max 5 mg) IM or intranasal via MAD OR 0.1 mg/kg (max 2.5 mg) IV
      • If seizures continue or re-occur repeat Midazolam (Versed) 0.2 mg/kg (max 5 mg) IM or intranasal via MAD OR 0.1 mg/kg (max 2.5 mg) IV; wait at least 5 minutes from initial dose
    • OR
    • Diazepam rectal gel (Diastat®) if available: Some patients with a diagnosed seizure disorder will have their own Diazepam rectal gel (Diastat®) prescribed by their physician. When available, Diastat can be given if no IV is available. Use the patient's prescribed dose or refer to the table below. If an IV is readily available, Midazolam is the preferred medication.
2-5 years old (0.5mg/kg)
Weight Dose
(kg) (lbs) (mg)
6-11 13-25 5
12-22 26-49 10
23-33 50-74 15
34-44 75-98 20

6-11 years old (0.3mg/kg)
Weight Dose
(kg) (lbs) (mg)
10-18 22-41 5
19-37 42-82 10
38-55 83-122 15
56-74 123-164 20