Seizure Recognition and Response

What every paraprofessional should know about seizures at school

Why this brief

Roughly 1 in 26 people will develop epilepsy in their lifetime. Many students with epilepsy are in mainstream classrooms, and many seizures occur during the school day. Some students have seizures the team has been told about — there's an Individualized Health Plan (IHP) and a Seizure Action Plan in the file. Some have a seizure for the first time at school, and the para is one of the first adults to respond.

This brief covers what to look for, what to do, when to call 911, and what to expect after. It does not replace the training your district provides — and many districts do not provide enough. The Epilepsy Foundation's free Seizure Recognition and First Aid Certification training (available online) is a strong first PD step for any para working with school-age students.

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| This brief is general. The student's plan is specific.If a student you support has epilepsy, the Seizure Action Plan in their file overrides anything in this brief. Read it. Know who their emergency contacts are. Know which rescue medication, if any, has been authorized. Know who, in your building, is trained to give it. Know where it's stored. If any of that is unclear, raise it with the school nurse — before, not during. |

1\. Types of seizures (the short version)

Seizures are often categorized in two broad groups based on where in the brain they start:

1.1 Generalized seizures (both hemispheres at once)

Tonic-clonic (formerly called grand mal): the seizure most adults picture — body stiffens (tonic phase), then jerks rhythmically (clonic phase), often with loss of consciousness, sometimes loss of bladder control or tongue biting.

Absence (formerly petit mal): brief lapses in awareness — staring spell, sometimes lip-smacking or rapid blinking, lasts seconds, no fall, often missed.

Tonic, clonic, atonic (drop attacks), myoclonic (sudden jerks): less common, named for the predominant motor feature.

1.2 Focal seizures (one part of the brain)

Focal aware (formerly simple partial): student remains aware; may have unusual sensations, twitching in one body part, sudden emotional shift.

Focal impaired awareness (formerly complex partial): consciousness is altered; student may be staring, fumbling with objects, walking aimlessly, repeating phrases. May not respond to their name.

Focal-to-bilateral tonic-clonic: starts focal, generalizes.

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| What you don't need to doYou don't need to diagnose the type. The school nurse, the family, and the neurologist do that. You need to recognize that something seizure-like is happening, respond appropriately, time it, and document what you saw. |

2\. Seizure first aid

The Epilepsy Foundation's universally recommended response is summarized as STAY • SAFE • SIDE. It applies to most seizures. Specific protocols may differ for individual students per their action plan.

2.1 STAY — stay with the person; time the seizure

Stay with them. Do not leave them alone. Note the start time.

Stay calm. Most seizures are scary to watch and end on their own.

Stay neutral toward bystanders. Calmly clear other students from the area or block the view.

2.2 SAFE — keep them safe

Move objects away that could hurt them — chairs, desks, hard objects.

Loosen anything tight around the neck. Glasses off if you can do it without forcing.

Cushion the head with something soft (a folded jacket, a backpack).

Do NOT try to stop the movements. Do NOT hold them down.

Do NOT put anything in their mouth. They cannot swallow their tongue. Putting something in their mouth can break their teeth or your fingers.

Do NOT give food, water, or medicine by mouth until they are fully alert.

2.3 SIDE — turn them on their side once movements stop

Recovery position: gently roll the student onto their side, with their mouth pointing slightly toward the ground. This keeps the airway clear in case of vomit or saliva.

Do not turn them while they are still convulsing if it requires force.

Stay with them until they are fully aware.

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| If the seizure happens in a wheelchair or seated positionDon't pull them out of the chair. Make sure they are securely strapped in. Tilt the chair gently so their head is supported. After the seizure, transfer to recovery position when it's safe to do so. |

3\. When to call 911

Most seizures end on their own within 1–3 minutes and do not require emergency response. Call 911 (or your district's equivalent) if any of the following apply:

The seizure lasts longer than 5 minutes (this threshold is the most important — sustained seizure activity is called status epilepticus and is a medical emergency).

A second seizure starts shortly after the first, before the student returns to baseline.

The student does not return to consciousness after the seizure stops.

The student is injured during the seizure (hit head hard, fell, bit tongue badly, etc.).

The seizure occurs in water (pool, bathtub) — even if it ends quickly.

The student has difficulty breathing after the seizure ends.

It is the student's first known seizure.

The student has diabetes, is pregnant, or has another medical condition that complicates seizure response.

The Seizure Action Plan in the student's file specifies 911 protocol that has been triggered.

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| Time matters. Watch the clock.If you don't have a watch or phone visible, ask someone else to time it. Note the start time and the time the convulsions stopped. EMS will ask. The 5-minute rule is the most consequential number in this brief. |

4\. Rescue medications

Some students with epilepsy are prescribed a rescue medication for prolonged seizures or seizure clusters. The most common in U.S. schools:

Diastat (rectal diazepam) — older, still common, requires specific training.

Nayzilam (intranasal midazolam).

Valtoco (intranasal diazepam).

State law and district policy govern who can administer these. Most states allow trained, designated school personnel — typically the school nurse, sometimes specifically delegated and trained school staff, sometimes including paraprofessionals — to administer rescue meds in accordance with the prescriber's order and the student's IHP. A para should never administer a rescue medication unless they have completed authorized training, are designated for that student, and the order is current.

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| Know the path before the seizureIf a student you support has a rescue medication: who is trained to give it, where is it stored, what's the trigger criterion (usually time-based, e.g., "if seizure exceeds 5 minutes, administer per order"), and what's the response after administration? You should be able to answer all four questions before the day starts. |

5\. After the seizure (post-ictal)

After the convulsions stop, the student enters a post-ictal state. They may be:

Disoriented, confused, or unable to speak.

Sleepy, often profoundly so.

Embarrassed, especially if there was loss of bladder control.

Unable to remember what happened.

In some cases, agitated or aggressive (a known post-ictal phenomenon, not deliberate).

Practical post-ictal care

Stay with the student. They should not be left alone until they are fully oriented.

Move them to a quiet, less stimulating space if possible.

Offer water once they are fully alert and able to swallow.

Help them clean up, with dignity, if there was loss of bladder control. Have a change of clothes ready in the file.

Notify the school nurse and the family per protocol.

Do not pressure the student to talk, return to class, or explain what happened. Recovery time varies; a student may need 30 minutes or several hours.

6\. Documentation

Every seizure observed at school should be documented. The school nurse usually owns the formal documentation, but the para is often the closest observer and the source of information. Useful information to capture:

Date and time the seizure started.

Activity the student was engaged in just before.

Pre-seizure signs (aura, change in behavior, complaint of feeling "funny").

What the seizure looked like: which side of the body, head turn direction, whether eyes were open, vocalizations, breathing, color change.

How long the convulsive phase lasted.

Loss of bladder or bowel control.

Injuries sustained.

How long until the student returned to baseline.

Whether rescue medication was given, by whom, time of administration.

Whether 911 was called and time of arrival.

Who was notified and when (family, nurse, supervisor).

7\. Triggers and prevention

Many students with epilepsy have known seizure triggers. Common ones:

Sleep deprivation.

Missed medication.

Illness, fever, dehydration.

Flashing lights, certain visual patterns (in photosensitive epilepsy — a smaller subset).

Stress, anxiety.

Hormonal cycles.

Specific to the individual — and listed in their plan.

The para is often well positioned to notice trigger exposure (a missed med dose at home, a poor night's sleep the parent mentioned at drop-off, an upcoming high-stress event) and to flag the team. Prevention is part of seizure management, not just response.

8\. Common pitfalls

Mistaking absence seizures for daydreaming or inattention. A student who repeatedly "goes blank" for several seconds and resumes activity may be having seizures that no one has identified.

Mistaking focal-impaired-awareness seizures for noncompliance, defiance, or autism stereotypies. The student is not choosing the behavior.

Trying to stop the convulsions by holding the student down.

Putting anything in the student's mouth.

Standing the student up too soon after the seizure.

Not timing the seizure.

Skipping the side recovery position.

Returning the student to class before they are fully oriented.

Not telling the family.

Treating a first-time seizure as if it were familiar — even if it looks like one you've seen before, a first seizure is a 911 call.

9\. Resources

Epilepsy Foundation — Seizure Recognition and First Aid Certification — epilepsy.com/learn — Free online training for school staff.

Epilepsy Foundation — Seizure Action Plans — epilepsy.com/recognition/seizure-action-plans — Templates and overview.

Epilepsy Foundation — School Resources — epilepsy.com/preparedness-safety/safety/schools — School-specific guidance.

CDC — First Aid for Seizures — cdc.gov/epilepsy — Plain-language first-aid summary.

National Association of School Nurses — nasn.org — Position statements on medication delegation and seizure management.

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