A teacher watches a student slump forward at her desk. The girl's eyes are open but vacant, her hands making small repetitive movements. The teacher has read the file. She knows the child has epilepsy. What she doesn't know is whether this is the seizure type that requires the medication in the nurse's office, or whether this passes on its own. She doesn't know if she should call 911 or call the parent first. The file doesn't say.

Non-parent caregivers are often expected to respond to seizures with no medical history, no training, and no clear threshold for when to act. If you're a teacher, babysitter, camp counselor, or family member who cares for a child with epilepsy, this is what you need to know before you're alone with them for the first time. (For parents managing seizures at home, see our complete guide to seizure first aid.)

What to Ask the Parent Before Day One

The conversation you need to have happens before the first seizure, not during it. These are the questions that will determine whether you know what to do when the moment comes.

Has your child had a seizure recently? What does it look like?

Parents can describe what you'll see. Tonic-clonic seizures involve the whole body: stiffening, then rhythmic convulsions, loss of consciousness. Absence seizures look like the child has briefly left the room, with a blank stare, sometimes repetitive blinking, lasting seconds. Focal seizures may involve confusion, unusual movements like picking at clothing, or loss of awareness in one part of the body.

Do you have a Seizure Action Plan? Can I have a copy?

A Seizure Action Plan is a one-page document that tells you the child's seizure type, typical duration, and exactly what to do. It should be signed by the neurologist. If the parent doesn't have one, ask them to request it. The Epilepsy Foundation provides templates.

Is there rescue medication? What is it, and when do I give it?

Rescue medication is prescribed for seizures that last longer than a certain threshold or for clusters of seizures. If the child has it, you need to know what it is, where it's kept, and the exact conditions under which you administer it. Not all children with epilepsy have rescue medication. If they do, you need hands-on instruction from the parent before you're responsible for giving it.

When do you want me to call 911 versus calling you first?

The 911 threshold varies by child. Some children have daily seizures that resolve in under two minutes and never require emergency services. Others need 911 on the first seizure or if the seizure lasts more than five minutes. The parent's answer to this question is the most important piece of information you'll have.

Who do I call after I call you?

Get the name and number of the child's neurologist. If the parent isn't reachable and you need guidance, the neurologist's office is the next call.

What to Do During a Tonic-Clonic Seizure

Start timing the moment the seizure begins. Glance at your phone or a clock. Duration is the single most important piece of information you'll document afterward.

Move any hard or sharp objects away from the child. Do not restrain them or try to stop the convulsions. If possible, place something soft under their head.

When the convulsions slow, gently roll the child onto their side in the recovery position, which keeps the airway clear if they vomit or produce excess saliva.

Stay with them through the entire event and into recovery. The period after a seizure is disorienting. They may be confused, exhausted, or frightened, and many don't remember what happened. Your calm presence is what helps.

What Not to Do

These are the instincts that feel protective but cause harm.

Do not put anything in their mouth. The idea that someone can swallow their tongue during a seizure is a myth. Putting fingers, a spoon, or any object between their teeth during a seizure risks broken teeth, a serious bite wound, and a blocked airway.

Do not hold them down. The convulsions cannot be stopped by force, and restraint increases the chance of injury.

Do not give anything by mouth during the seizure. Swallowing is not possible during a tonic-clonic event.

Do not leave them alone. The confusion after a seizure can last from minutes to over an hour. The child should not be left to come back to awareness by themselves.

Rescue Medication: What It Is and How to Give It

Rescue medication is used to stop a seizure that has lasted beyond the threshold specified in the child's Seizure Action Plan, or to prevent a second seizure when clusters are a known pattern. If the child you care for has rescue medication, you need to know how to administer it before the moment arrives.

Diastat (rectal diazepam) is a gel administered rectally. The parent or school nurse should walk you through the process before you're alone with the child. Remove the syringe from the tube, lubricate the tip, insert it gently into the rectum, push the plunger, and hold the child's buttocks together for three minutes to prevent the medication from coming back out.

Nayzilam (midazolam nasal spray) and Valtoco (diazepam nasal spray) are sprayed into one nostril. They're easier to administer than diastat and work within minutes. The parent should demonstrate the device and confirm the dose with you.

Rescue medication is only given when the Seizure Action Plan specifies it. Do not administer it on your own judgment. The plan will state the exact conditions: seizure lasting five minutes, seizure in water, or a second seizure before full recovery from the first.

After giving rescue medication, call 911 if the plan directs it. Some plans require emergency services after any rescue medication use. Others do not. Follow what the plan says.

Absence and Focal Seizures

Absence seizures require no physical intervention and pass quickly. Your job is to observe and document: what time it started, how long it lasted, and any movements you saw.

For focal seizures where the child seems confused but conscious, guide them gently away from anything dangerous. Do not physically restrain them. Speak calmly. Watch to see whether the seizure generalizes into a tonic-clonic event, which would require the full response above.

When to Call 911

The parent should have told you the 911 threshold for their child. If they didn't, or if you're uncertain, use this list:

• The seizure lasts more than five minutes
• The child does not regain consciousness or awareness after the seizure ends
• A second seizure begins before the child has fully recovered from the first
• The child is injured during the seizure
• The seizure happens in water
• It's the first seizure you've ever seen this child have

A seizure that stops on its own within the threshold specified in the Seizure Action Plan and is followed by normal recovery does not require emergency services. Call the parent immediately to report what happened.

Documenting What You Saw

Every seizure should be documented before the details fade. Write down:

• When the seizure started and how long it lasted
• What the body did: which limbs were involved, whether the child was conscious, whether the eyes moved or turned in a particular direction
• What happened in the moments before: any unusual sound, sensation, or posture change that preceded the event
• How long recovery took and how the child seemed in the hour after

The parent will relay this information to the neurologist. Your documentation is a critical part of the child's care.

The Fear You're Carrying

If you've never seen a seizure before, the fear of doing it wrong is real. Teachers describe the moment a student seizes in their classroom as the longest two minutes of their career. Babysitters describe calling the parent mid-seizure, unsure whether to hang up and call 911 instead.

That fear doesn't mean you're unprepared. It means you're responsible for someone else's child during a medical event, and you take that seriously. The steps above are what turn that fear into capability. You know what to do. You know what not to do. You know when to call for help.

Parents who entrust their child to you understand the weight of that responsibility. They've lived through seizures themselves. What they need from you is the willingness to ask the questions before day one, to follow the Seizure Action Plan when the moment comes, and to document what happened so the neurologist has the information they need.