Red Flags & When to Go In Person for Seizure (Suspected) - Pediatric Triage

Audience: pediatric

Suspected seizures in children can be frightening and require careful attention. Telemedicine can help assess symptoms and guide families on next steps. However, some signs indicate that immediate in-person medical care is necessary to ensure safety and proper treatment. This guide explains common red flags to watch for, what telemedicine can and cannot handle, and how to prepare for a virtual visit. It also covers important aftercare steps and answers frequent questions. Remember, telemedicine is a helpful tool for initial assessment but is not a replacement for emergency or urgent in-person care when danger signs appear.

Red flags — go in person / ER

• Seizure lasting more than 5 minutes — call emergency services immediately.
• Repeated seizures without regaining consciousness between episodes — seek urgent in-person care.
• Difficulty breathing, blue lips or face, or unresponsiveness after a seizure — go to the emergency room right away.

What telemedicine can do

• Initial symptom assessment and history taking.
• Reviewing seizure videos if available.
• Providing guidance on monitoring and safety at home.
• Advising when to seek emergency or specialist care.
• Scheduling follow-up appointments or referrals.

What telemedicine cannot do

• Performing physical neurological examinations.
• Administering emergency seizure treatments.
• Ordering or conducting diagnostic tests like EEG or imaging.
• Managing prolonged or severe seizures remotely.
• Providing urgent airway or breathing support.

Understanding Suspected Seizures in Children

A seizure happens when there is sudden, uncontrolled electrical activity in the brain. In children, seizures may look like shaking, staring spells, or unusual movements. Sometimes, symptoms can be subtle or confused with other conditions. Telemedicine can help observe and discuss these symptoms to decide if further care is needed.

When to Seek Immediate In-Person Care

Certain signs mean your child needs urgent medical attention. These include seizures lasting more than 5 minutes, repeated seizures without recovery in between, difficulty breathing, or if your child is unresponsive after a seizure. Also seek care if the child has a head injury, fever with seizures, or if this is their first seizure.

How Telemedicine Can Help

Telemedicine can provide initial evaluation by reviewing symptoms, medical history, and video observations if available. It can guide families on monitoring, medication use, and when to seek emergency care. Telehealth providers can also help arrange referrals for in-person tests or specialist visits.

Limitations of Telemedicine for Seizures

Telemedicine cannot perform physical exams, emergency treatments, or diagnostic tests like EEGs or brain imaging. It cannot treat prolonged or severe seizures remotely. If your child shows any red flags or worsening symptoms, in-person care is essential.

Preparing for a Telemedicine Visit

Before your tele-visit, have a list of your child's symptoms, seizure details, and any videos of the event ready. Know your child's medical history and current medications. Ensure a quiet space with good lighting and a stable internet connection for the consultation.

After the Telemedicine Visit

Follow the provider's instructions carefully. This may include monitoring your child, giving prescribed medications, or scheduling follow-up appointments. If symptoms worsen or new red flags appear, seek emergency care immediately.

How to prepare for your tele-visit

• Have detailed information about the seizure event: duration, movements, and behavior before and after.
• Gather your child's medical history and current medications.
• Record a video of the seizure if possible and safe to do so.
• Ensure a quiet, well-lit space with a reliable internet connection for the tele-visit.
• Prepare a list of questions or concerns to discuss with the healthcare provider.

After your tele-visit

• Follow the healthcare provider's instructions on monitoring and medication.
• Keep a seizure diary noting frequency, duration, and triggers.
• Schedule any recommended in-person follow-up or specialist visits.
• Seek emergency care if any red flag symptoms appear.
• Educate caregivers and family members on seizure first aid and safety measures.

FAQs

Can telemedicine diagnose my child's seizure?

Telemedicine can help assess symptoms and guide next steps, but it cannot definitively diagnose seizures without in-person examination and tests. A healthcare provider may recommend further evaluation in person.

What should I do if my child has a seizure during a telemedicine visit?

If your child has a seizure during the visit, stay calm and ensure their safety by moving sharp objects away. Do not restrain them. If the seizure lasts more than 5 minutes or they have trouble breathing, call emergency services immediately.

Are all seizures in children emergencies?

Not all seizures require emergency care, but some signs like prolonged seizures, repeated episodes without recovery, or breathing difficulties are emergencies. When in doubt, seek prompt medical evaluation.

How can I keep my child safe after a seizure?

Place your child on their side to keep the airway clear, remove nearby hazards, and stay with them until fully alert. Follow your healthcare provider's advice on medication and monitoring.

When should I record a video of a seizure?

If it is safe to do so, recording a seizure can help healthcare providers understand the event better. Only record if it does not put your child or others at risk.

Sources

1. Seizures in Children — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Epilepsy and Seizures — Centers for Disease Control and Prevention (CDC).
3. Seizures - Symptoms and Causes — Mayo Clinic.
4. Seizures in Children: When to Seek Emergency Care — American Academy of Pediatrics (AAP).

This telemedicine guidance is for educational and triage purposes only. It is not a substitute for professional in-person medical evaluation, diagnosis, or treatment. If your child shows any emergency signs or if you are concerned about their health, seek immediate in-person care.