What midazolam looks like
Midazolam is a clear solution that comes in a plastic ampoule.
Plastic ampoules of midazolam come in 2 different volumes:
- 3mL of solution (5mg/mL) which contains 15mg of midazolam
- 1mL of solution (5mg/mL) which contains 5mg of midazolam
Make sure you check which one you have before you use it.
A photo of a plastic ampoule of midazolam.
Source: KidsHealth
The prescription the doctor gives you will tell you how much of the solution to give. You will also find this information in your seizure plan and on the medicine packet.
Midazolam also comes in a glass ampoule. Make sure your child gets a plastic ampoule from the pharmacy, not a glass ampoule.
Equipment needed for giving midazolam
You will need to get syringes to give midazolam. You don’t need a needle as you will not inject the midazolam.
You need 1mL or 3mL syringes. This depends on the dose of midazolam your child needs.
You need intravenous (IV) syringes (not oral syringes) because they fit into the midazolam plastic ampoule. You can get these syringes from the local pharmacy, hospital or GP practice.
The type of syringe you will need - an IV syringe.
Source: KidsHealth
If your child will be having midazolam in the nose, you will need an atomiser device. An atomiser device attaches to the syringe. A health professional will give you an atomiser device with the midazolam if that is how they want you to give it to your child.
An atomiser device that attaches to the syringe.
Source: KidsHealth
How to store midazolam
Keep midazolam in a safe place out of sight and reach of children.
Store the midazolam ampoules at room temperature. Don’t leave the midazolam in a hot place like your car or bathroom. Keep it away from light.
The midazolam comes in a box of 5 ampoules which are in foil. The box may say the midazolam is for injection, but you will not be injecting it into your child.
A photo of the box and foil packet that midazolam comes in.
Source: KidsHealth
Midazolam expiry date
There is an expiry date on the box, but the midazolam will expire 8 months after you remove the ampoules from the foil. Check with your pharmacist when your ampoules will expire and write this date on the box.
Regularly check the midazolam hasn’t expired and return any expired midazolam to your pharmacy. If you need an ongoing supply, you can get this from your GP.
How to prepare the midazolam
A video demonstrating how to prepare midazolam before giving it to your child.
Source: KidsHealth
Steps on how to draw up midazolam
Follow these steps if your child’s seizure is still actively going at 4 minutes.
Before you start, make sure you know what dose of midazolam your child needs. This will be on your seizure plan and the packet.
Get your midazolam and a syringe.
Twist off the top of the plastic ampoule of midazolam.
Insert the syringe into the ampoule so that it fits tightly.
Hold the syringe upright with the ampoule above the syringe.
An illustration of hands preparing midazolam. The medicine is being drawn up into a syringe from a ampoule.
Source: KidsHealth
transcribeTranscript
The illustration shows two hands preparing midazolam. One hand holds an ampoule of medicine upside down, while the other hand pulls down on the plunger of a syringe to draw liquid into it.
A black arrow points downward along the syringe to show the direction of the medicine being drawn.
At the top left is the KidsHealth logo with the website: kidshealth.org.nz
Pull the syringe so the midazolam moves from the ampoule into the syringe. There are numbers on the side of the syringe so you can measure the right dose.
Gently push out any big air bubbles.
Check that the correct amount of midazolam is in the syringe.
Take the ampoule off the syringe.
How to give the midazolam to your child during a seizure
Give the midazolam as directed by your doctor. Midazolam can be given either in between the teeth and cheek (buccal) or in the nose (intranasal). Your doctor will prescribe the best way to administer midazolam for your child.
For general advice on what to do during your child’s seizure, see the KidsHealth page on seizure first aid.
Instructions for giving buccal midazolam
Wipe off excess saliva and open your child’s lips.
Slowly, over a few seconds, squirt the midazolam from the syringe into the space between the teeth and the cheek - the cheek closest to the ground if they are on their side.
There is no need to open your child’s jaw - they do not need to swallow the midazolam. It’s not harmful if your child does swallow the midazolam, but it will not work as well. The midazolam is absorbed quickly into the bloodstream through the inner side of the cheek.
An illustration showing a child receiving buccal midazolam during a seizure.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up of a child lying on their side, mid-seizure. Their eyes are half open and their body is shaking, indicated by movement lines around the head and arms.
A hand is holding a syringe at the child’s mouth. The syringe is positioned inside the cheek to give medicine buccally (into the side of the cheek).
At the bottom left is the KidsHealth logo with the website: kidshealth.org.nz
You can wash and dry the syringe after using it. You can use it again in the future.
See an emergency plan with steps on what to do if your child has a seizure and how to give buccal midazolam.
Print your child’s emergency plan and keep it with the midazolam. Refer to this plan when your child has a seizure.
Instructions for giving intranasal midazolam
Attach the syringe to the atomiser device.
Put the atomiser with the syringe attached into your child’s nostril.
Give half of the dose into one nostril.
Remove from the first nostril and insert into the other nostril to give the rest of the dose.
An illustration showing a child lying on their side having a seizure while medicine is given into their nose.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up of a child lying on their side, mid-seizure. Their eyes are half open and their body is shaking, shown with movement lines around the head and arms.
A hand is holding a syringe fitted with a nasal adaptor. The syringe is positioned at the entrance of the child’s nostril to give medicine intranasally (into the nose).
At the bottom left is the KidsHealth logo with the website: kidshealth.org.nz
You can wash and dry the atomiser and syringe after using it. You can use it again in the future.
See an emergency plan with steps on what to do if your child has a seizure and how to give intranasal midazolam.
Print your child’s emergency plan and keep it with the midazolam. Refer to this plan when your child has a seizure.
Emergency Plan For Giving Intranasal Midazolam For A Seizure
What to do after giving your child midazolam
After you have given midazolam:
- watch your child’s breathing
- continue to time the seizure
Call 111 within New Zealand and ask for urgent medical help if:
- the seizure does not stop within 1 minute of giving the midazolam
- you are worried about your child’s breathing
If your doctor has given you specific instructions on when to call 111 follow their instructions.
Printable emergency seizure plan
An emergency seizure plan is a step-by-step guide for what to do if your child is having a seizure. It includes steps to take for giving buccal or intranasal midazolam.
The emergency seizure plans are available as a flow chart or as text instructions.
Print out a plan and keep a copy with your supply of medicine.
Follow the links to see all available formats. The emergency seizure plans are both available as either a flow chart or as text instructions.
Emergency Plan For Giving Buccal Midazolam For A Seizure
Emergency Plan For Giving Intranasal Midazolam For A Seizure
Preview
An illustrated emergency seizure plan. It explains what to do if your child is having a seizure. It shows when to give emergency seizure medicine (midazolam), how to give it into the side of the cheek (buccally), and how to help your child recover safely.
Source: KidsHealth
transcribeTranscript
The illustration is a seizure first aid plan titled What to do if your child is having a seizure.
At the top, a teal box reads: Give midazolam if the seizure lasts over 5 minutes or if ____ seizures happen within ____ minutes.
Ten numbered steps are listed:
- Stay calm and reassure your child.
- Make sure your child is in a safe place. If not, lay them down on the floor, or move furniture or sharp objects.
- Start timing the seizure. Video the seizure if possible.
- At 4 minutes of seizure activity prepare the midazolam (15mg/3ml) = ____ml. An illustration shows two hands preparing midazolam in a syringe.
- At 5 minutes of seizure activity give midazolam into the side of the cheek (buccally). An illustration shows the medicine being given inside a child’s cheek with a syringe.
- Call 111 for an ambulance when you give the midazolam, unless instructed otherwise by your doctor.
- Watch your child’s breathing.
- When the seizure has finished place your child in the recovery position. An illustration shows a child lying on their side with labels: Head tilted to keep airway open, Hands support head, mouth is toward the ground, Knee stops body from rolling.
- Let your child rest and recover in a calm and quiet space until back to normal.
- Document the seizure in a seizure diary. If instructed, let your medical team know about the seizure.
At the bottom of the illustration is a green box with a QR code and text:
'For more detailed information, see Seizure First Aid on KidsHealth by scanning the QR code or visiting www.kidshealth.org.nz/seizure-first-aid'
At the bottom left is the KidsHealth logo with the website: kidshealth.org.nz.
An illustrated emergency seizure plan. It explains what to do if your child is having a seizure. It shows when to give emergency seizure medicine (midazolam), how to give it into the side of the cheek (buccally), and how to help your child recover safely.
Source: KidsHealth
transcribeTranscript
The illustration is a flowchart titled What to do if your child is having a seizure.
Text at the top reads: Give midazolam if the seizure lasts over 5 minutes or if ___ seizures happen within ___ minutes.
- On the left side, a black vertical bar marks the timeline: 0 minutes, 4 minutes, 5 minutes.
- At 0 minutes, a box reads: Seizure starts. Inside are the steps: Start timing the seizure, stay calm, move your child to a safe place, reassure your child. In bold, it adds: Video the seizure if possible.
- A green arrow labelled Continues points down to 4 minutes: A hand draws liquid into a syringe. Text reads: Draw up ____ ml of midazolam (15mg/3ml).
- A green arrow labelled Continues points down to 5 minutes: A child is shown receiving medicine into the side of the cheek. Text reads: Give midazolam into the side of the cheek (buccally). Below it says: Call 111 unless instructed otherwise by your doctor.
- A navy blue line labelled Stops comes from each of the boxes at 0 minutes, 4 minutes and 5 minutes. They all point to the right-hand side box. Text reads: Put your child in the recovery position. A child lies on their side with text labels: Head tilted to keep airway open. Hands support head. Mouth is toward the ground. Knee stops body from rolling.
- Below this, a yellow box reads: Let child rest & recover. Stay with them until back to normal. Record in seizure diary. If advised, let medical team know. Dr ______.
At the bottom of the illustration is a green box with a QR code and text:
'For more detailed information, see Seizure First Aid on KidsHealth by scanning the QR code or visiting www.kidshealth.org.nz/seizure-first-aid'
At the bottom left is the KidsHealth logo with the website: kidshealth.org.nz.
Acknowledgements
Illustrations by Dr Greta File. Property of KidsHealth.
The content on this page has been developed and approved by the Paediatric Neurology Clinical Network, Paediatric Society New Zealand.
