It's important to individualize recommendations for children with seizures. Epilepsy can affect each child very differently.  A number of factors need to be considered such as:

  • Seizure type and frequency
  • Medication side effects
  • Other medical or developmental problems that affect a child's activity
  • The child's ability to follow instructions and act responsibly
  • The type of activity or exercise
  • Safety precautions or suvervision
  • Benefits of exercise and participating in activities

Common sense should be the guiding force in making these decisions. The goals should be both safety and a lifestyle that is as normal as possible for the child. 

  • While no activity is completely safe, restricting children from many activities can limit the child too much.  Restriction and isolation foster low self-esteem and emphasize the disability.
  • Certain activities and sports can be dangerous for some children, especially if seizures are not well-controlled. Talk about each activity with the child's health care team first. Most often, they can help figure out a way to let the child be active, participate and have fun. 
  •  Children whose motor control or consciousness is impaired during seizures are at higher risk for injuries.
  • Children who have uncontrolled, frequent seizures should know that certain activities are restricted. For example, they should not swim alone or swim over their head. In fact, no child should swim alone! 
  • Children with any type of seizures should play or exercise with a buddy if possible. 
  • Wear appropriate safety gear for the desired sport or activity. 
  • Ride a bike on a path or at a park where it's safe and not near cars. Ride with someone and don't forget the helmet! 
  • If a child's seizures are more common at certain times (within 2 hours of awakening, for example), activities can be scheduled for the times when seizures are less likely to occur.

Exercise rarely provokes seizures. It is possible though, especially if the child gets too tired or dehydrated while exercising.

  • If a pattern between seizures and exercise is seen, limit that type of exercise.
  • Or try the activity for shorter periods of time, rest frequently and stay well-hydrated. 
  • Encourage the activity during the coolest parts of the day in hot weather. 
  • The amount or intensity of exercise may be gradually increased if the child tolerates it without any problems. 

Children and teens with epilepsy should be encouraged to participate in group and competitive sports, such as Little League baseball, community sports, and varsity sports at school. These activities are usually well supervised.

  • When appropriate safety gear for the sport is used, most children with epilepsy can safely participate without special accommodations.
  • Most important, group activities are part of childhood and foster a sense of "belonging," high self-esteem, and independence. These benefits are extremely valuable, and usually outweigh the risk of injury. 
  • Most potential hazards can be overcome. In fact, players with epilepsy can be found in major league baseball, ice hockey, and other professional sports.
  • Serious injuries in children with epilepsy are uncommon and rarely occur during participation in sports. Believe it or not, bathrooms are much more dangerous to children than playing soccer or ice skating.

Climbing is a great exercise and fun for all of us. Climbing can also be part of evey day life, such as needing to climb stairs at home, school or work. For the vast majority of children and teens with epilepsy, stairs should not be barriers to getting around. However, seizures that impair motor control or consciousness can cause serious injuries if they occur on a staircase.

Recreational activities that involve climbing should not be off limits, however, carefully consider the risks and benefits for each child with epilepsy. Examples of activities that involve climbing may include: climbing walls or ropes, obstacle courses, or hiking. 

  • If a child has an aura, or warning, before a seizure, he or she may be able to sit down on a flat area until the seizure is over. 
  • If the child has frequent seizures that cause falling, safety straps and gear should be used for climbing walls or rope courses. Other protective gear such as helmets and padding can be worn when hiking to lessen risk of injury.   
  • Always have a trusted adult available for recreational activities and use the buddy system. 
  • If adaptive aids are needed for any climbing activities (stairs or recreational activities),  include plans for safety including supervision needs and adaptive aids in the child's 504 or educational plan. 

Swimming is a pleasure all children should be encouraged to enjoy. Although water poses special dangers for children with seizures, there is usually a way to make this a safer activity for most children. The main question is -  how much supervision is needed?  

  • Children with severe or frequent seizures can enjoy the water if a parent or caregiver holds them in a shallow pool or body of water. Wear a life jacket too! 
  • Children with well-controlled seizures can be encouraged to swim with reasonable safety tips.
    • Make sure that at least one person who knows the child has epilepsy and who knows basic lifesaving is nearby.
    • Make sure the child knows how to swim. 
    • Depending on the child's health, ability to swim, and amount of available supervision, children with seizures should avoid swimming in deep water.
  • Tips for children with occasional seizures that affect motor control or awareness. 
    • Supervise the child closely. Seizures are unpredictable and many are difficult to detect. 
    • Encourage swimming only when a lifeguard is on duty who is responsible and aware of the child's disorder, as well as another child in the pool who is the buddy. The lifeguards should know that they must keep their eyes on the pool while the child is swimming.
    • The buddy system (used by many camps for children and by adult scuba divers) is another precaution to keep children safe. The buddy should be responsible, understand the need for keeping an eye on the child, and should never go far away in the pool.

Open bodies of water:

  • Swimming in a lake, bay, or ocean is much more dangerous than swimming in a pool. A person swimming in open waters can disappear in seconds and be impossible to locate quickly.
  • Generally, children with epilepsy should swim only in clear water, where they are always in sight.
  • If a child with epilepsy, especially one with poorly controlled seizures, is swimming in open waters, he or she should wear a lifejacket.

Competitive swimming:

  • The child with epilepsy who wants to swim competitively should be encouraged. Competitive swimming practices and matches are usually well supervised.
  • The coach should be aware that the child has epilepsy. Everyone involved, including the child, should recognize that there is some additional risk to this activity and make an informed decision about whether it is worth it.

Other water activities:

  • Older children with well-controlled seizures can snorkel and may even scuba dive, but should talk to their doctor first.
  • Children with uncontrolled seizures that impair consciousness or motor control should not scuba dive and should only snorkel in relatively calm water, very close to someone who has lifesaving skills.
  • High diving poses clear dangers for children with epilepsy. The child or teenager should get individual medical advice from their doctor to weigh the benefits and risks of diving. 

Bicycles are a part of childhood. Yet a bicycle, if ridden on or near the street, presents a serious potential danger for a child with epilepsy. Even if a parent rides just behind the child on the sidewalk, during a complex partial seizure the child may suddenly veer off into the street, out of the parent's reach and protection. There are tips to make bike riding safer and more fun.

  • Everyone who rides a bicycle should wear a helmet. Injuries on bikes most often involve the head.
  • If the seizures are under control or do not impair motor control or consciousness, bicycle riding should not be restricted.
  • Ride bikes in a park or other safe place away from motor vehicles. 
  • Stationary bicycles for exercise pose no serious danger for children with epilepsy. Ideally, the floor should be carpeted or padded. Low-seated bicycles are the safest.
  • Horseback riding can be safe and fun for children whose seizures are well controlled or always preceded by a warning.
  • Those who have seizures that could cause them to fall off the horse can ride but must be closely supervised. Someone may need to walk alongside the horse. The risks and benefits of horseback riding must be carefully weighed for these children.
  • Competitive horseback riding often involves galloping and jumping and should only be considered for children with mild or well-controlled epilepsy.

Contact sports such as football, basketball, soccer, rugby, and ice hockey are generally safe for children with epilepsy.

  • The main concern with contact sports is the chance of head or bodily injury, but children with epilepsy are not necessarily more likely to be hurt than other children. If an absence or complex partial seizure were to occur during a game, there is a small chance of injury if someone were to tackle the child, for instance, during the spell.
  • Tackle football, rugby, and ice hockey have a higher incidence of injuries than most other sports and participation in them should probably be limited to children with well-controlled seizures.
  • There is nothing wrong with a child who has occasional or even frequent seizures playing touch football in the back yard.
  • Don't forget to weigh the risks against the benefits of the sport. The chances of serious injury are small compared with the positive effects of team participation.
  • Boxing should be avoided by all children, especially those with epilepsy. Boxing can result in head injuries. 
    • Since a momentary lapse can mean taking a hard hit directly to the head, children with absence seizures or complex partial seizures are at particular risk of injury from boxing.
    • Head injuries also can aggravate a seizure disorder.
    • Wrestling may be safe for children with well-controlled seizures or seizures that do not impair consciousness or motor control. It can be dangerous for other children with epilepsy.

What about activities that involve heights?

Some forms of gymnastics are dangerous for children with epilepsy.

  • Only those with well-controlled seizures should consider performing on the high bar, uneven parallel bars, vaults, or rings.
  • Other gymnastic events, such as floor routines and the pommel horse, pose little risk.
  • The parallel bars are of intermediate risk; the risk reflects the specific exercises being done.
  • Climbing a rope higher than 5 feet is also dangerous if seizures are not well controlled.


Authored By:

James W. Wheless MD
Joseph I. Sirven MD

Reviewed By:

Joseph I. Sirven MD | Patty Osborne Shafer RN, MN

on Sunday, July 27, 2014


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