A tonic-clonic seizure (also called a “grand mal” seizure) happens when there is a sudden burst of unusual electrical activity in the brain. During the seizure, a child isn’t aware of what is going on around them, their body becomes stiff, and then their arms and legs begin to jerk. These seizures usually last one to three minutes and stop on their own. Afterward, a child may feel confused, tired, or have a headache. This is called the postictal (post-IK-tul) phase. It usually lasts just a few minutes, but it can be longer.

Treatment for seizures usually includes medicines. A neurologist (a doctor who treats problems with the brain and spinal cord) helps find out what caused the seizure and what treatment is needed.

Here’s how to care for your child and keep them safe if they have another seizure.

Follow your healthcare provider’s instructions for:

• Any medicines your child should take
• If any "triggers" (such as fever, flashing lights, lack of sleep, or medicines) can make a seizure more likely
• Precautions your child should take to prevent drowning such as:
  • Never swimming alone
  • Taking showers only, no baths, and keeping the bathroom door unlocked
• Whether it’s OK for your child to ride a bike or drive a car
• Whether your child needs to wear a medical alert bracelet
• When to follow up

If your child has another seizure:

1. Gently lower your child to the floor.
2. Put your child on their side to prevent choking.
3. Put something small and soft under your child's head and loosen any tight clothing.
4. Move sharp or breakable objects out of the way.
5. If your healthcare provider prescribed medicine to stop the seizure, give the medicine as directed. But don't try to give your child any medicine (pills or liquid), food, or drinks by mouth until the seizure is over and they're fully awake.
6. Stay with your child until the seizure is over and they are fully awake.

Important information:

• During the seizure, don’t try to hold your child down or put anything in their mouth.
• If the seizure lasts more than five minutes, call 911.
• When the seizure is over, let your child rest as needed.
• Keep a record of when the seizure happened, how long it lasted, and what happened before, during, and after the seizure.
• Make sure caregivers, coaches, and staff at your child’s school know what to do if your child has a seizure.

• Your child has another seizure.
• Seizures are different from your child’s usual pattern.
• Your child is hurt during a seizure.
• Your child is not acting like themselves after recovery.
• You have questions about medicine or side effects.

• Your child has a seizure lasts longer than five minutes or has another seizure right after the first one.
• Your child has trouble breathing or their skin or mouth turns bluish during or after the seizure.
• Your child does not wake up or respond after the seizure.
• The seizure happens in water.

What happens during a seizure? The brain works using electrical signals. A seizure is a sudden increase in these electrical signals. A seizure that affects both sides of the brain is called generalized. A seizure that involves only one side of the brain is called focal. A tonic-clonic seizure is a type of generalized seizure.

Can someone feel a seizure coming? Some people get an aura before a seizure. During an aura, a child might have a strange taste or smell, feel fearful, or see flashing lights.

What causes a tonic-clonic seizure? Tonic-clonic seizures can run in families. They may also be caused by an infection, injury to the brain, electrolyte (minerals and salts) imbalances, changes in genes (mutations), brain tumor, and other medical conditions. Sometimes the cause isn’t known.

What problems can happen? Some children with tonic-clonic seizures can have problems with learning and development. Also, many kids with seizures feel stressed about having another seizure. Support your child by helping them learn about seizures. Ask them if they want to talk to a counselor or join a group with other kids who have seizures. Your healthcare provider can help you find resources for your child.