Administering rectal diazepam

Many teachers become very apprehensive at the thought of diving rectal diazepam. The government states that parents and head teachers must respect such concerns and not put pressure on staff to assist in treatment. We hope that by reading this advice leaflet and with support from the epilepsy specialist nurse or school nurse, you will feel more confident about making an informed decision.

By administering rectal diazepam in schools, a child receives appropriate first aid treatment.

Seizures in children should stop after 5-10 minutes but occasionally they can go on for longer. If a single seizure or a series of seizures lasts for 30 minutes or more, this is called status epilepticus. Very occasionally, prolonged seizures like this may harm a child. To try to prevent prolonged seizures, rectal diazepam has been prescribed for use at home and at school as a first aid medication.

No – giving paracetamol to a reluctant child is much more difficult. Rectal diazepam should be a two-person procedure in schools and written consent to administer it should be obtained from parents first. Training will be given in school, by the school nurse or the epilepsy nurse specialist.

You should do everything possible to maintain the child’s privacy and dignity during the procedure.

No – the tubes are very narrow and rounded and the lining of the rectum, though soft, is very strong. You will not damage a child by giving rectal diazepam. In most cases the child will be totally unaware of the procedure.

Take the tube out of the foil packaging by tearing the top.
Check the dose is correct before removing the packaging.
Twist the plastic cap on the end of the tube.
Place the child on his or her side and draw up their knees.
Remove as little clothing as is needed to allow access to their bottom.

If the child is under three years old, insert the nozzle end into the back passage (anus), up to the first mark on the tube.

If the child is aged three years or over, insert it up to the widening point of the tube (hilt).

Squeeze the contents into the bottom by pressing the bulb of the tube with your thumb and forefinger.

Once empty, squeeze the child’s buttocks together and slowly withdraw the tube, maintaining pressure on the bulb of the tube.

Keep the buttock together for 15-30 seconds following the removal of the tube in order to prevent any medication seeping out.

The child’s doctor, in consultation with the parents, will have prescribed rectal diazepam and the medical responsibility for the use of diazepam lies with the GP or consultant who prescribed it.

This is not usually necessary if the seizure stops after you have given diazepam.

You should call 999 for an ambulance at the same time as giving the diazepam if it is the first time it has been given, because with any medication there is always a very slight risk of a reaction. If the seizure does not stop following one dose of diazepam you may give a second dose but only if detailed on the child’s care plan.

As well as hopefully stopping the seizure, it will make the child sleepier than they usually are following a seizure. The child should be allowed to sleep in a safe place, observed and not left alone. In a very small number of cases a child may become more irritable and restless. If the child cannot be roused from sleep after one hour, call 999 for an ambulance so he or she can be seen in hospital.

This can happen. We advise that you do not give more diazepam. If the seizure does not stop, call 999 for an ambulance and tell the paramedic what has happened.

The effects are not immediate. If the diazepam is effective, expect to see a result after 5-8 minutes. The child will then usually sleep. He or she can remain in school provided the parents agree and the school is able to provide a member of staff who can stay with the child.

It does not need to be kept in a fridge but avoid extremes in temperature – a safe place away from children but easily accessible by staff if needed.

Yes, this is important. Schools will need to have a care plan that everybody, including parents, are happy with. Care plans will be arranged by your epilepsy nurse and should include:

• a list of staff who have been trained to give diazepam, with written permission from parents
• a care plan for the use of diazepam written by the child’s hospital doctor and stating the dose to be given
• clear instructions stating when it is necessary to call an ambulance
• clear instructions stating how and when to inform parents that rectal diazepam has been given
• what to do with the rest of the class whilst dealing with a child having a seizure.

This is not an exhaustive list because each school’s plan for dealing with children with epilepsy will be individual and you may need to include additional information appropriate to your school.

This position ensures that:

• an unconscious child maintains an open airway
• the tongue cannot fall to the back of the throat
• the head and neck remain in an extended position so that the air passage is widened
• any saliva or vomit in the child’s mouth will drain freely.

The position of the child’s limbs provides the necessary stability to keep the body propped in a safe and comfortable position.

Babies should be positioned on their side.

For further advice contact:

• GP
• health visitor
• school nurse
• paediatrician
• Epilepsy nurse specialist on 01206 745358
• Children’s Community Nursing team

www.epilepsy.org.uk