# Pediatric seizure / convulsions

Use weight-based seizure treatment, monitor ventilation, and contact base for every patient.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-seizures/
Official source: [SO-P-075 — Seizure / Convulsion - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Base contact is required even if the seizure stops or the patient is not transported.
- Support ventilation and airway protection after medication; do not rely on cessation of visible motor activity alone.

## Source documents

- [SO-P-075 — Seizure / Convulsion - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-75%20Seizures%20peds.pdf)

## Recognize the emergency

- Treat ongoing seizure activity or repeated episodes without recovery of consciousness. Turn to the side, protect the airway, and suction when possible.
- Status epilepticus includes a seizure longer than 5 minutes or repeated seizures without recovery. Subclinical activity can present with abnormal vital signs, gaze deviation, or a clenched jaw.

## Midazolam by weight

- Preferred: 0.2 mg/kg IM once, maximum 10 mg.
- If IM cannot be delivered or IV/IO is already present: 0.1 mg/kg IN/IV/IO, maximum 5 mg. Repeat once after 3 minutes for continuing or recurrent seizures.
- Keep the preferred one-dose IM pathway distinct from the lower-dose alternate-route repeat pathway.

## Oxygenation, ventilation & glucose

- Monitor SpO₂ and available waveform capnography. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
- Assist with BVM when ETCO₂ is at least 50 mmHg.
- Check glucose: treat at or below 60 mg/dL, or use field impression at 60–80 when hypoglycemia is suspected. D10 is 5 mL/kg IV (maximum 250 mL); glucagon 0.5 mg IM if IV cannot be established. The IO dextrose exception requires unconsciousness, glucose below 60, no IV, and no response to glucagon.

## Required contact & handoff

- Make base contact for every transported and non-transported pediatric seizure patient; pediatric-capable base preferred. Provide ALS escort to the nearest appropriate ERC.
- Report weight, seizure duration/pattern, recovery or persistent altered state, glucose, medication route/dose/time, and respiratory response.