Paediatric Seizure Emergency Dosing — Nigeria · Kenya · Ghana
Step-up protocol: diazepam → lorazepam → phenobarbitone → phenytoin.
Weight-based, capped at maximum doses. APLS/WHO 2023. Offline-capable.
For qualified healthcare professionals only.
Doses sourced from Advanced Paediatric Life Support (APLS) 7th Ed., WHO pocket book for hospital care of children, BNF for Children 2024, and RCPCH seizure guidelines 2023.
Ensure resuscitation equipment and oxygen are available. Report an error
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Clinically reviewed by
Dr. Emeka Eze, FWACP (Paeds)
Paediatric Emergency Physician, Lagos University Teaching Hospital
Paediatric seizures and status epilepticus require rapid, weight-accurate anticonvulsant dosing within precise time windows. The standard of care since the PREDICT and ConSEPT trials now recommends treating all seizures lasting ≥5 minutes with benzodiazepines immediately — the previous 30-minute definition of status epilepticus has been abandoned in clinical practice. Delays in treatment or dose errors worsen neurological outcomes. Causes of paediatric seizures in sub-Saharan Africa differ from high-income settings and include cerebral malaria, bacterial meningitis, hypoglycaemia, and hyponatraemia alongside structural epilepsy — always treat the underlying cause. This calculator implements WHO IMCI seizure management, current evidence from the PREDICT trial, and FMOH Nigeria emergency paediatric guidelines.
Advanced Paediatric Life Support (APLS) guidelines, 6th edition — Status epilepticus
Frequently Asked Questions
If IV access available: IV lorazepam 0.1 mg/kg (max 4 mg) or IV diazepam 0.3 mg/kg (max 10 mg) — give slowly over 2–3 minutes. If no IV: rectal diazepam 0.5 mg/kg (max 10 mg) or buccal/intranasal midazolam 0.2–0.3 mg/kg. Repeat once after 5–10 minutes if seizure continues. Check blood glucose urgently — give 2 mL/kg 10% dextrose IV if hypoglycaemic.
Second-line (refractory status epilepticus): IV phenobarbitone 20 mg/kg over 20–30 minutes (max rate 1 mg/kg/min) — monitor for respiratory depression, have bag-mask ventilation ready. Alternative: IV phenytoin 20 mg/kg over 30–60 minutes (max rate 1 mg/kg/min) — requires cardiac monitoring. IV levetiracetam 40–60 mg/kg is increasingly used as second-line where available.
Treat as emergency immediately: seizure lasting >5 minutes (do not wait for 30 minutes), any seizure in a febrile child under 1 year, any seizure with impaired consciousness between episodes, focal seizure, or history of known epilepsy with breakthrough seizure. Always check capillary blood glucose as the first bedside investigation — hypoglycaemia is rapidly fatal and easily treatable.
Phenobarbitone IV loading dose is 20 mg/kg given slowly IV at a maximum rate of 1 mg/kg/minute (to avoid respiratory depression and hypotension). The maximum single load is 40 mg/kg over 2 hours in refractory status epilepticus. For IV administration, phenobarbitone must be diluted and given slowly with continuous monitoring of respiratory rate, oxygen saturation, and blood pressure. IM administration has unreliable absorption in shock. Phenobarbitone is the WHO essential medicine first choice for neonatal seizures and the second-line agent for paediatric status epilepticus after benzodiazepines.
Levetiracetam IV (Keppra) at 40–60 mg/kg (maximum 3 g) given over 5–15 minutes is increasingly used as a second-line agent for established status epilepticus, particularly where phenytoin is unavailable or contraindicated. It is available in some Nigerian and Kenyan tertiary hospitals. Advantages over phenytoin: no cardiac monitoring required, safer in liver disease, no drug interactions with ACTs or TB drugs. Disadvantages: higher cost, not universally available. Where neither levetiracetam nor phenytoin is available, phenobarbitone remains the WHO-recommended second-line agent.
Related calculators
For weight-based dosing of other common paediatric medicines including antibiotics and analgesics, see the Paediatric Drug Dose Calculator.
For seizure management in neonates, including phenobarbitone dosing by gestational age, use the Neonatal Drug Dosing Calculator.
To monitor a child's clinical trajectory after a seizure, use the PEWS Score Calculator.
📋 Guideline basis: NICE CG137 2022 · BNFc 2024 · APLS 6th ed · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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