Buccal midazolam: is a test dose in hospital needed?

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". Inconvenience for families making the trip to hospital An extra day off school Staying the day in an unfamiliar environment The test dose is given to a conscious child and therefore does not mimic its use during a seizure; some consider this unethical Use of hard pressed acute care paediatric beds, nursing care, and medical time.