A Seizure/Epilepsy Action Plan helps guide parents and caregivers to provide safe and effective care for children with epilepsy.

1. Position your child in the recovery position

​	​Remain calm Move the child away from danger and lay the child flat on the ground
​	​ Position child on his/her side Keep head and neck straight If possible, place the back of the hand under the cheek
​	Pull the far leg (above the knee) up and across towards you
​	Wipe away any secretions to keep the mouth clear

2. Prepare the Rectal Diazepam

​	Rectal Diazepam 1 tube = 5mg ½ tube = 2.5mg
​	If your child is: Less than or equal to 3 years old = Insert only half the nozzle into the anus More than 3 years old = Insert the entire nozzle into the anus
​	Twist and remove the cap from the nozzle of the Rectal Diazepam tube
​	If your neurologist has prescribed only half of the contents (2.5mg) for your child, squirt and remove half of the content before inserting the nozzle into the anus

3. How to administer Rectal Diazepam

​	Lay the child on his/her side
​	Insert the nozzle into the anus and squeeze the contents of the tube in
​	Remove the tube without releasing the pressure to prevent the medication from being sucked back into the tube Hold the buttocks together for 3 to 4mins to prevent leakage
​	DO NOT administer more than the prescribed dose of Rectal Diazepam at any one time

Do’s

• Stay calm. Don’t panic!

• Ensure the child is away from danger.

• Place the child in recovery position (see above).

• Note the starting time of seizure.

• Observe the child’s seizure pattern and stay with the child until he/she regains consciousness.

• Follow the Epilepsy Action Plan (Green, Yellow, Red zone as appropriate).

Don’ts

• Do not attempt to put objects such as a spoon or your fingers into your child’s mouth. Biting the tongue is not dangerous to your child, but inserting objects may harm his/her mouth and teeth.

• Do not shake or tap the child vigorously.

• Do not restrain the child’s movements.

• Do not feed the child fluid/medication (doing so may cause choking).

Record the following in the seizure diary:

• Clear description of seizure pattern.

• Date and duration of seizure.

• Possible trigger factors (e.g. bright flickering lights, lack of sleep etc.)

• Possible warning signs (aura) just before seizure (e.g. feeling fearful, nausea, headache, sensing unusual smell etc.)

If you child is on seizure medication:

1. Never stop or reduce seizure medication(s) even if your child is better or seizure-free. Only neurologists can adjust or discontinue medication.

2. If he/she misses a dose, take the missed dose immediately. But if it is less than 3 to 4 hours to the next dose, skip the missed dose and take the next dose at the usual time. Never double dose! (Record such events in the seizure diary)

3. If he/she vomits within 5 to 10mins after taking the medication, repeat the dose. (Record such events in the seizure diary)

4. When seeing another doctor or the dentist, always inform the doctor/dentist that your child is taking seizure medication regularly

5. Avoid letting your child:

6. • Consume grapefruit juice (it increases the level of seizure medications and causes toxicity)

   • Take antibiotics such as Erythromycin and Clarithromycin with Carbamazepine as it can cause drug interactions and toxicity (e.g. drowsiness)

   • Consume ginkgo nut and evening primrose oil (may trigger seizure)

7. Always check with your neurologist or pharmacist before giving any other medicines to your child such as traditional medicines, supplements or herbal products.

1. Change in seizure pattern in your child

2. Increase in seizure frequency in your child

3. If your child experiences drug allergies or severe side effects from the seizure medication(s)

 Ref: K21