Immediate approach

If seizure is ongoing

1. Time it.
2. Place her on her side on a safe surface, loosen clothing around the neck.
3. Do not restrain her or put anything in her mouth.
4. Call emergency services if it lasts 5 minutes or more, repeats without full recovery, or breathing is impaired.
5. In a clinical setting: ABCDE assessment, oxygen/ventilatory support as needed, check bedside blood glucose, obtain IV/IO access, and treat prolonged convulsive seizure per local pediatric status-epilepticus protocol.

If the seizure has stopped and she has returned to baseline

1. Confirm it was likely a seizure and look for a provoked cause

• Duration, focal onset features such as one-sided jerking, eye/head deviation, impaired awareness, cyanosis
• Fever or infectious symptoms, vomiting/diarrhea, poor intake
• Recent head trauma
• Possible medication, household chemical, cannabis, or other ingestion
• Sleep deprivation, prior staring/jerking episodes
• Developmental history, birth history, prior neurologic illness
• Family history of seizures/epilepsy
• Full neurologic examination and signs of meningitis/encephalitis

2. Tests: targeted, not routine in a well child

• Bedside glucose is appropriate early.
• Routine blood tests are not usually needed.
• Check electrolytes, calcium, renal function, etc. if there is dehydration, vomiting/diarrhea, poor intake, persistent altered consciousness, suspected metabolic disease, or another clinical indication.
• Toxicology testing if accidental ingestion is possible or the cause remains unclear.
• Lumbar puncture only if meningitis or encephalitis is suspected, for example fever with concerning appearance, neck stiffness, persistent altered mental status, or ongoing seizures. Textbook guidance similarly advises against routine labs, emergency imaging, and LP in a child who has fully returned to baseline without relevant clinical features. Tintinalli's Emergency Medicine: A Comprehensive Study, p. 936.

3. EEG and brain imaging

• Arrange urgent pediatric/paediatric neurology or first-seizure clinic review, ideally within 2 weeks. This matches the NICE first-seizure quality standard.
• EEG: obtain promptly when the history suggests an epileptic seizure. It helps classify seizure type and estimate recurrence risk. It is often arranged outpatient if the child is well, though early EEG can have a higher yield. Tintinalli's Emergency Medicine: A Comprehensive Study, p. 936.
• Emergency CT or MRI is not routine after a brief generalized seizure with normal recovery and exam.
• Obtain urgent neuroimaging if there is focal seizure onset, persistent focal deficit/Todd paralysis, persistent altered mental status, suspected raised intracranial pressure, significant trauma, severe persistent headache, concern for abuse, or known condition predisposing to intracranial pathology.
• MRI is preferred for non-urgent structural assessment when focal features, abnormal neurological/developmental findings, or abnormal EEG suggest it. ROSEN's Emergency Medicine Concepts and Clinical Practice, p. 3288.

4. Disposition and treatment

• Completely back to normal baseline
• Normal exam and observations
• No concern for infection, poisoning, trauma, metabolic cause, or safeguarding issue
• Reliable caregivers and clear safety-net instructions
• Prompt follow-up is arranged

Parent safety advice until reviewed

• Never leave her unattended in the bath, pool, or near water.
• Use showers only with direct supervision as appropriate for age.
• Avoid climbing/heights and cycling/scooters without close supervision.
• Teach all caregivers seizure first aid and ask them to record another event on video if safely possible.
• Return urgently for any repeat seizure, seizure lasting 5 minutes or more, incomplete recovery, fever with ill appearance, persistent vomiting/headache, weakness, or abnormal behavior.