Midazolam has been given via the buccal route for the acute management of prolonged seizures for some years. Buccal administration is preferable to the rectal route for parents and carers.¹ There is evidence that midazolam given in this way is more effective in curtailing seizures than diazepam and that there is no difference in the incidence of side effects.²

In some districts, including our own, if the family and the prescribing clinician want to use buccal midazolam the child is admitted as a day case to an acute paediatric ward for a “test dose”. This has a number of disadvantages, particularly for children with autism or complex …