From the Guidelines
If your 1-year-old has a seizure, immediately call 911 if it lasts more than 5 minutes, and seek emergency medical care for a first-time seizure, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. To ensure the child's safety, lay them on their side on a flat surface away from harmful objects, and do not put anything in their mouth or restrain them, as stated in the guidelines 1. Time the seizure, and after it stops, keep the child on their side until fully awake. The guidelines emphasize the importance of activating emergency medical services (EMS) for seizures lasting >5 minutes, multiple seizures without return to normal, seizures in water, seizures with injuries, breathing difficulty, or choking, and seizures in infants <6 months of age 1. At the hospital, doctors may perform tests like an EEG, blood tests, or brain imaging to determine the cause, and for recurrent seizures, a pediatric neurologist might prescribe medications like levetiracetam (Keppra) or valproic acid (Depakote) at doses appropriate for the child's weight. Some key points to consider:
- Febrile seizures are common in young children and typically don't require medication, as they are usually self-limited and resolve spontaneously within 1 to 2 minutes 1.
- Antipyretics such as acetaminophen, ibuprofen, or paracetamol are not effective for stopping a seizure or preventing a subsequent febrile seizure, as demonstrated by two meta-analyses published in 2021 1.
- The recovery position is intended to reduce the risk of aspiration if the person vomits during the seizure or the postictal period, and first aid providers should stay with the person having a seizure and minimize the risk of injury by helping the person to the ground and clearing the area around them 1.
From the Research
Immediate Response to a 1-Year-Old's Seizure
If a 1-year-old experiences a seizure, it is crucial to remain calm and act quickly. The following steps can be taken:
- Ensure the child's safety by clearing the area around them of any hard or sharp objects.
- Gently turn the child onto their side to prevent choking on saliva or vomit.
- Loosen any tight clothing around the child's neck.
- Do not attempt to restrain the child or stop the seizure with physical force.
- Time the seizure to inform medical professionals of its duration.
Medical Treatment
According to 2, benzodiazepines are the first line of treatment for seizures in children. Specifically, lorazepam is preferred due to its long-acting effects. If the seizure is refractory to benzodiazepines, other medications such as phenytoin or valproate may be used.
Administration Methods
Intranasal midazolam has been shown to be an effective and rapid treatment for acute seizures in children, as demonstrated in 3, 4, and 5. It offers a valuable alternative to intravenous or rectal benzodiazepine administration, which can be difficult or socially awkward. Intranasal midazolam has a shorter interval between hospital arrival and seizure cessation compared to IV/rectal BDZ, as reported in 4.
Additional Considerations
In cases where the seizure is refractory to initial treatment, ketamine may be considered as a third or fourth line agent, as suggested in 6. However, more research is needed to fully understand its role in treating status epilepticus. It is essential to seek immediate medical attention if a child experiences a seizure, as prompt treatment can help prevent complications and improve outcomes.