Childhood Epilepsy: Activities, Safety, and First Aid

One of the most important roles parents play in the lives of children is keeping them safe and healthy. For any child, this requires a great deal of time and attention, but for a child with epilepsy, the commitment may be even greater.

Staying Healthy and Happy

Given the emphasis placed on controlling seizures and protecting a child from harm if a seizure should occur, parents sometimes lose sight of other needs that may be equally important to a child's development and happiness. Physical activities, such as sports, and social activities, such as camps and school dances, can provide some of the most memorable moments in a child's life as well as important opportunities for a child to develop skills that lead toward greater independence.

Kids with epilepsy should be able to participate in as many normal, typical activities as possible. Many kids with epilepsy go swimming, ride bikes, go on sleepovers, play hockey, and play soccer.

Elizabeth Thiele, MD, PhD

Although providing physically challenging opportunities may seem incompatible with efforts to keep a child with epilepsy safe, this is not necessarily the case. In fact, studies have shown no link between athletic activities, including contact sports such as football, and an increase in the number or severity of seizures. And although seizures that impair consciousness or motor control may increase the risk of injury during some activities, if a child's seizures are well controlled, there is little reason to limit his or her participation in activities considered safe for the general public. Furthermore, there are many enriching opportunities even for children whose seizures are not well controlled, and parents should encourage their children to take part in these activities.

There is no general rule regarding activities for children with epilepsy. Experts recommend a case-by-case approach, in which decisions about participation are based on a child's seizure type, his or her level of seizure control, risks inherent to the particular activity, and accommodations that can be made in light of the child's condition. Although some sports still impose blanket restrictions on the participation of anyone who has ever had a seizure, most activities do not. It is therefore up to the parents, the child with epilepsy, and the child's physicians to decide which activities are appropriate for the child and how best to minimize any risks that participation might pose.

Daily Activities

Not all childhood activities are athletic or social events, but even common daily activities can provide opportunities for growth and independence, especially for young children. These activities may also pose risks to a child with epilepsy, and in some cases special considerations should be made.

Stair climbing is one such activity. All children with epilepsy will encounter stairs, and many will do so on a regular basis, including at school. Children who experience auras before a seizure should be particularly careful if they have one on or near a staircase. Children who have frequent seizures are often advised to use elevators instead of stairs or to use stairs only when accompanied by an adult or older child.

Bathing is another regular activity that requires special consideration by parents of children with epilepsy. No child with epilepsy, regardless of age, should be allowed to take a bath unsupervised. As children get older and require more privacy, physicians generally recommend that they take showers instead of baths.

Sports

Swimming

Swimming and other water sports are favorite activities for many children, including children with epilepsy. However, because water poses a particular risk, close supervision may be required. The level of supervision a child needs while swimming depends on the type of seizures he or she has and how well the seizures are controlled. A child whose seizures affect consciousness or motor control and are poorly controlled should be closely supervised by a lifeguard who knows about the child's condition. In contrast, children whose seizures are well controlled require less supervision, although they should never swim alone. Children with epilepsy who want to swim competitively should be encouraged to do so, especially given that practices and meets are typically well supervised. A coach should always be informed of the child's condition.

Other Water Sports

Children with epilepsy can enjoy other water sports, such as water skiing, snorkeling, scuba diving, and boating, although some require special precautions depending on a child's seizure type and level of seizure control. A child whose seizures are not well controlled and affect consciousness should not scuba dive and should only snorkel in calm water near someone who has lifesaving skills. Those with well-controlled seizures can scuba dive or snorkel. All boaters, whether they have epilepsy or not, should wear life jackets. As with other activities, boaters with poorly controlled seizures require more supervision than those with well-controlled seizures.

Bicycling

Bicycling is a terrific form of exercise and provides many children with an opportunity for independence. For some children with epilepsy, however, bicycling poses a serious risk. Children whose seizures affect consciousness or motor control may suddenly veer off of a path or sidewalk, out of a parent's reach and protection. For this reason, children who have such seizures should not ride near roads or other hazards and instead restrict their bicycling to parks and other places where cars are not permitted. Children whose seizures are well controlled or do not affect consciousness or motor control need not be restricted. Because most serious bicycle injuries involve the head, all cyclists should wear helmets.

Contact Sports

While contact sports such as football, rugby, ice hockey, and soccer have a higher incidence of injury in general than most other sports, they do not necessarily pose any greater risk to a child with epilepsy. Studies have shown no connection between such sports and an increased frequency or severity of seizures. However, children with epilepsy whose seizures cause loss of consciousness, no matter how brief, may be at greater risk of injury than the average player.

Gymnastics

Not surprisingly, jumping to and swinging from great heights, as is done in gymnastics, can pose serious risks to some children with epilepsy. How great a risk depends upon the specific event, the seizure type, and the level of seizure control a child has. In general, events that take place high above the gym floor, such as high bar, uneven bars, vaults, rings, and balance beam, pose the greatest risk and should only be performed by children whose seizures are well controlled. In contrast, floor routines and pommel horse pose little risk and are an option for any child.

Team vs. Individual Sports

Children with epilepsy can participate in team as well as individual sports. However, because it is common for people with epilepsy to experience problems with attention or working memory, team sports can be problematic for some. Sports such as football and basketball require players to quickly recall plays that they have learned in practice and apply them to a game situation. A problem with the working memory would make this type of recall more difficult or less efficient for a person with epilepsy than for the average player. For this reason, some children with epilepsy may gravitate more toward individual activities and sports that involve routines, such as gymnastics, dance, karate, golf, or yoga, than toward team sports. These sports can also offer a level of socialization often found in team sports and can positively impact a child's self-esteem.

Camp

Camp is a regular part of many children's experiences, whether they have epilepsy or not. Outdoor camps, sports camps, overnight camps and day camps all provide valuable social interaction, as well as physically and intellectually challenging activities. As with other activities, a child's seizure type and level of seizure control affect the level of supervision he or she requires at camp. A child with well-controlled or only occasional seizures generally can attend regular camp, with precautions in place for that particular child determined in advance.

For children whose seizures are not well controlled, there are camps designed specifically for children with epilepsy. Because all students at the camp have epilepsy, attendees typically feel more at ease and better understood than they do in regular, unaffected peer groups. Also, because epilepsy is something all children at the camp share, the disorder loses some of its significance, allowing the children to focus on interests more typical of kids of their age.

Driving

Inevitably children with epilepsy look forward to the prospect of getting their driver's license. Driving is part of American culture and one of the ultimate signs of independence. However, the combination of epilepsy and driving evokes obvious safety concerns. As with other activities, seizure type and level of control will dictate a person's ability to operate a vehicle safely.

Because of the inherent danger associated with operating a motor vehicle—with or without epilepsy—driving is considered by society to be a privilege, not a right. As such, individuals must be licensed to drive, and in most states a person with epilepsy must submit a letter or form from a doctor stating that the individual is fit to drive. If an individual's seizures are well controlled, most states will issue a driver's license to that person. Adolescents whose seizures remain uncontrolled are not allowed to obtain a driver's license in the United States.

Driving laws by state

Who Should Know?

Anyone who is teaching, caring for, coaching, or otherwise closely related to a child with epilepsy should be informed about the child's disorder and be prepared to respond in a medically appropriate way. Often, because the term epilepsy continues to carry a stigma, parents and children with epilepsy may be uncomfortable sharing this information. Regardless of the stigma and associated feelings, it is important that the child's health take precedence over other concerns. The more parties informed about a child's condition, the more likely someone will be available to act quickly in case of an emergency.

More on how to talk about epilepsy

First Aid Response

The correct response to an individual having a seizure depends largely on the type of seizure and its duration. Although seizures may be frightening to observe, they are rarely dangerous. In some cases, however, a seizure may last for 15 minutes or more or may recur without sufficient time for recovery in between. This condition is called status epilepticus and is considered a medical emergency. If an individual experiences a seizure that lasts more than 5 minutes or repetitive seizures without respite, call 911 immediately so that he or she may be transported safely and quickly to an emergency room.

If an individual has a seizure, it is important to follow a few simple guidelines:

1. Help the person lie on the floor, on his or her side.
2. Do not put anything in the person's mouth.
3. If the seizure lasts more than 5 minutes, call for paramedics.
4. Try to remain calm.

Download first aid information (PDF)

Important Points to Remember

• Protecting a child with epilepsy from harm is important, but so too is providing opportunities for the child to fully experience life.
• Children with well-controlled seizures can participate in nearly all activities and sports.
• Many daily activities, such as walking up and down stairs and bathing, pose risks for some people with epilepsy.
• Depending on a child's seizure type and level of seizure control, there may be many or few restrictions on the child's activities.
• Camp can be an exciting and memorable experience for a child. Depending on his or her prior experience, a child may choose between a regular camp and a camp designed for children with epilepsy.
• Driving is an important milestone in an adolescent's life. Depending on the child's state of residence, seizure type, and level of seizure control, he or she may or may not be able to obtain a driver's license.
• It is important that all caretakers of a child with epilepsy know about the child's condition.
• Quick first aid response is important in the case of prolonged seizures.