21 Sports and Activities
Having epilepsy does not mean your child should sit on the sidelines. In fact, the opposite is true: physical activity is good for children with epilepsy, and most can participate fully in sports and recreation with a little planning. The goal is not to avoid risk entirely, but to manage it thoughtfully so your child can enjoy the same benefits of exercise, teamwork, and confidence that every child deserves.
21.1 The Big Picture: Exercise Is Good for Epilepsy
For decades, children with epilepsy were told to avoid sports. That advice has changed. Research shows that physical activity can actually reduce seizure frequency, improve mood and self-esteem, and lead to a better quality of life. Seizures are rarely triggered by exercise. Even vigorous activity, including contact sports, is safe for most children with epilepsy1–3.
The benefits go beyond seizure control. Children with epilepsy are at higher risk for anxiety, depression, and social isolation. Being part of a team, learning a sport, and staying physically active can help with all of these3,4.
21.2 Which Sports Are Safe?
Most sports are safe for most children with epilepsy. The International League Against Epilepsy (ILAE) divides sports into three groups based on what could happen if a seizure occurred during the activity1,2.
Group 1: No significant additional risk. These are sports where a seizure would not put your child or others at meaningful risk of injury. Most children with epilepsy can participate freely.
- Team sports on the ground (soccer, basketball, baseball, volleyball, football, rugby)
- Track and field (most events)
- Racquet sports (tennis, table tennis)
- Dancing, bowling, golf, cross-country skiing, curling
- Contact sports such as judo and wrestling
Group 2: Moderate risk to the child, but not to others. These sports carry some additional risk if a seizure occurs, but can usually be done safely with appropriate supervision and precautions.
- Swimming
- Cycling
- Gymnastics
- Horse riding
- Skating, skateboarding, snowboarding
- Alpine skiing
- Archery, fencing
- Ice hockey, weightlifting
Group 3: Major risk. These sports carry a high risk of serious injury or death if a seizure occurs. They are generally not recommended for children with active seizures.
- Scuba diving
- Motor sports
- Rock climbing at height
- Skydiving or parachuting
- Platform or springboard diving
- Surfing, windsurfing
- Aviation
The right decision depends on your child’s specific situation: how well their seizures are controlled, what type of seizures they have, whether they get a warning before a seizure, and how comfortable your family is with a given level of risk. Your epilepsy team can help you think through the details for any specific sport.
21.3 Swimming and Water Safety
Water deserves special attention. Drowning is the most common cause of injury-related death in people with epilepsy, and children with epilepsy have a drowning risk several times higher than other children5.
That said, many children with epilepsy swim safely, and some swim competitively. The key is supervision. Your child should never swim alone or in unsupervised open water. Children with poorly controlled seizures should have one-to-one direct supervision in or near the water, not just a lifeguard watching from a distance. A lifeguard adds an extra layer of protection but is not a substitute for a dedicated supervisor. When age-appropriate, showers are preferred over baths, since bathtubs are a common site of drowning in epilepsy. And when boating, your child should always wear a life vest.
Talk to your epilepsy team before your child begins swim lessons or joins a swim team, especially if seizures are not yet well controlled.
A child with epilepsy should never swim without a dedicated person watching them one-to-one, close enough to help immediately. This is the single most important precaution in this chapter, because a seizure in the water can become dangerous within seconds.
21.4 Contact Sports and Head Injury
Parents often worry that contact sports will make seizures worse. Current evidence does not support this concern. There is no evidence that the minor head trauma typical of sports like football, soccer, basketball, or martial arts increases seizure frequency or causes epilepsy to worsen2.
Standard protective equipment such as helmets, mouthguards, and pads should be used as recommended for any child in that sport. There is no need for extra protective gear solely because of epilepsy in most cases, though your epilepsy team may have specific recommendations depending on your child’s seizure type.
21.5 Exercise and Medications
Some parents worry that exercise might change how seizure medications work. While intense exercise can theoretically affect how the body processes certain medications, studies have not shown clinically meaningful changes in drug levels during physical activity2. Your child does not need routine blood level checks just because they are active, though your doctor may recommend them for other reasons.
A few practical medication-related tips are worth keeping in mind. Some seizure medications can cause fatigue or coordination problems, especially when starting or adjusting doses, so your child may need time to adjust before returning to full activity. Some medications, such as zonisamide (Zonegran) and topiramate (Topamax), can reduce sweating, which increases the risk of overheating during exercise, especially in hot weather. Make sure your child stays well-hydrated and takes breaks in the heat. Finally, sleep deprivation is a well-known seizure trigger. If your child’s sport involves early morning practices, late-night games, or travel across time zones, pay attention to sleep.
21.6 Talking to Coaches and Activity Leaders
Just as you would give a teacher a seizure action plan, coaches and activity leaders need the same information. A short conversation at the start of the season can prevent confusion and panic if a seizure happens during practice or a game.
Cover the basics:
- What your child’s seizures look like and how long they typically last
- What to do (and what not to do) during a seizure
- When to give rescue medication, if one is prescribed
- When to call for emergency help
- Any activity-specific precautions (for example, one-to-one supervision during swimming)
If your child has a written seizure action plan, give a copy to the coach. If rescue medication is prescribed, confirm that someone trained to give it will be present at practices and games, and that the medication is accessible and not locked in a car or left at home.
21.7 When to Reassess
Your child’s ability to participate in sports may change over time as seizure control improves or worsens, medications are adjusted, or your child grows and takes on new activities. A sport that was not appropriate when seizures were frequent may become perfectly safe once seizures are well controlled.
The ILAE suggests that after 12 months of seizure freedom, most people can participate in all sports, including those in the higher-risk categories1,2. If your child’s seizure pattern changes, or if they want to try a new activity, check in with your epilepsy team.
21.8 The Bottom Line
Epilepsy is not a reason to keep your child out of sports. It is a reason to plan ahead. With the right precautions, good communication with coaches, and guidance from your epilepsy team, most children with epilepsy can be as active as they want to be, and they will be better for it.