A kid mid-practice or in the parking lot before the game starts shaking, eyes rolling, body stiffening. Most parents have never seen a seizure in person. The protocol below works whether the kid has a known seizure history or not.
Recognize.
The signs of a generalized tonic-clonic seizure (the most common type seen in kids):
Stiffening of the body, rigid posture (tonic phase, lasts seconds).
Rhythmic jerking of arms and legs (clonic phase, lasts 30 seconds to a few minutes).
Loss of awareness, eyes may roll back or fix.
Loss of bladder or bowel control sometimes.
Lips and skin may turn slightly blue from breathing irregularity during the seizure.
Most seizures end on their own within 1 to 3 minutes.
Febrile vs other seizures.
Febrile seizures occur in kids under 6 with high fever, usually associated with infection (ear infection, viral illness, sometimes the early stage of strep). The kid may have been “off” earlier in the day or running a fever the parent did not catch.
Non-febrile seizures in older kids may indicate epilepsy, head injury, electrolyte imbalance, or other causes. The on-field protocol is the same; the medical workup after differs.
The protocol.
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Time it. Note the start time. Most parents lose track of time during a seizure; it always feels longer than it is. Use a phone clock.
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Lower the kid to the ground if they are standing. Cushion the head with whatever soft material is at hand (a folded jacket, a backpack).
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Roll the kid onto their side (recovery position). This keeps the airway clear if they vomit.
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Move dangerous objects away. Glasses, helmets, hard objects within reach.
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Loosen tight clothing around the neck.
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Do not put anything in the kid’s mouth. The “swallowing the tongue” myth is not real. Putting a finger or object in produces broken teeth, bitten fingers, and blocked airway.
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Do not try to restrain the movement. Hold the kid’s environment safe; do not hold the kid still.
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Wait. The seizure will end. Most do within 2 minutes.
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After the seizure, the kid will be confused, sleepy, sometimes briefly unable to speak (postictal state). This lasts 5 to 30 minutes. Stay with them. Reassure.
When to call 911 immediately.
A seizure that lasts more than 5 minutes.
A second seizure right after the first ends.
The kid was injured during the seizure (hit head on something, fell from height).
The kid has trouble breathing or stays blue after the seizure ends.
The kid does not regain consciousness in the postictal period (still unresponsive 10 to 15 minutes after movement stops).
This is the kid’s first seizure ever and they do not have a known seizure disorder.
The seizure happened during or after a head injury.
The kid has diabetes or another condition that can cause seizure.
The kid is in water during the seizure (drowning risk).
When to call the pediatrician (not 911) after the kid recovers.
The seizure was brief (under 5 minutes), the kid recovered to baseline, and the family has handled febrile seizures with this kid before. The pediatrician will want to evaluate the underlying fever and the seizure event but transport may not need to be 911.
For first-time seizures, even if the kid recovers fast, emergency room (ER) evaluation is appropriate to rule out underlying causes.
For team managers and coaches.
Have on the master roster a flag for any kid with known seizure history. Note the parent contact and any rescue medication on hand (some families carry intranasal midazolam or rectal diazepam for kids with prolonged-seizure history).
If a parent has provided rescue medication and written authorization, the procedure is in the kid’s care plan. Otherwise, do not administer.
After the event, document time of onset, duration, what was happening before, what the kid did during, and what happened after. The receiving ER will need this.
For parents.
If your kid has known seizure disorder, the team should have a written care plan from the neurologist. The plan covers triggers, rescue medication if any, and 911 thresholds.
For a one-off febrile seizure with no prior history, the American Academy of Pediatrics (AAP) guidance is that most do not require chronic anti-seizure medication. The kid is at slightly elevated risk for another febrile seizure but not for adult epilepsy.
The thing parents miss most.
The “don’t put anything in the mouth” rule. Old folk advice (a stick, a wallet) produces real injury. Do not do it.
The “hold them still” instinct. Restraining the seizing body produces injury to the kid and the helper. Make the environment safe and let the seizure run.
The honest read. Most seizures in youth athletes are scary to watch and resolve fully. The right protocol is light: keep the kid safe, time it, position on the side, wait. Call 911 for the criteria above. The kids who recover most fully are the kids whose surrounding adults stayed calm and followed the protocol that the AAP and Epilepsy Foundation publish openly.
If this content is reaching someone watching a seizure right now, time it, position the kid on their side, do not put anything in the mouth, call 911 if it crosses 5 minutes or recurs.