The balance between a child's safety and the ability to enjoy a full range of activities is tested when it comes to recommendations regarding sports and other physical activities. Because epilepsy affects each person differently, the approach must be individualized. The seizure type and frequency of the seizures, the type of medication and its adverse effects, the child's ability to follow instructions and act responsibly, and the nature and supervision of the activity must all be considered.

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. No activity is completely safe. Making safety the exclusive concern will unnecessarily limit the child's activities. Restriction and isolation foster low self-esteem and emphasize the disability. Nevertheless, certain activities and sports can be dangerous for some children with epilepsy, and safety concerns require that these activities be forbidden or carefully supervised. In the past, doctors and parents tended to strictly limit physical activities. The current trend is to allow children with epilepsy to be children and to pursue as full a range of activity as reasonable.

The type of seizures and their frequency are critical in determining which activities are safe. 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 (in fact, no child should swim alone), or play on high bars or climb ropes without a proper mat and supervision. Other activities, such as riding a bicycle in traffic, should be forbidden. However, bicycling may be permitted in safer settings. 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.

Seizures are only rarely provoked by exercise, but when this pattern is identified, physical exertion should be limited. However, it may be possible to devise a satisfactory program of exercise in which the level of exertion is gradually increased. Prolonged physical activity in a hot environment may provoke seizures in some children. In such cases, plenty of cool drinks and frequent rest periods can help reduce the risk of seizures.

Children 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 and require appropriate safety gear, and 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 the risks of participation must be serious to warrant prohibiting a child from joining group activities. 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.

Stair Climbing

Our world is filled with stairs. For the vast majority of children 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 while the child is on a staircase. If a child has an aura, or warning, before a seizure, he or she may be able to sit down until the seizure is over. If the child has frequent seizures that cause falling, it is not unreasonable to have him or her use elevators, not stairs. In school, however, this restriction can cause the child to be late for classes or to stand out from schoolmates. In these unusual cases, a buddy who is aware of the epilepsy may be able to accompany the child from one class to the next.

Bathing

Children with epilepsy should not bathe in a bathtub unsupervised. Children should take tub baths only when they can be supervised moment to moment. A child can drown in a bathtub with only 2 inches of water. As children get older, however, they need privacy, and this means that they must take showers. Bathroom doors should never be locked.

Swimming and Water Sports

Swimming is a pleasure all children should be encouraged to enjoy. Although water poses special dangers for children with epilepsy, epilepsy is not an insurmountable barrier to swimming. The issue of epilepsy and water safety is really a question of how much supervision is necessary. No matter how severe or frequent the epilepsy, a child can enjoy the water. A parent can hold a child in a shallow pool with little risk, for instance. If the child's seizures are well controlled, swimming should be encouraged, although it is necessary to make sure that at least one person who knows the child has epilepsy and who knows basic lifesaving is nearby. This person can be a teenager. The most difficult decisions about swimming arise when children have occasional seizures that impair motor control or consciousness. These children should be allowed to swim, but they must be closely supervised. There should be a lifeguard on duty who is responsible and aware of the child's disorder as well as another child in the pool who is the buddy. Unfortunately, lifeguards are often immature adolescents who may be easily distracted. 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 young children who swim (and by adult scuba divers), is another precaution to ensure a child's safety. The buddy should be responsible, understand the need for keeping an eye on the child, and should never go far away in the pool. 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. Therefore, extreme caution must be exercised when a child with epilepsy, especially one with poorly controlled seizures, swims in open waters. The wearing of a lifejacket is recommended in this setting.

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, however, and 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.

Older children with well-controlled seizures can snorkel and may even scuba dive. 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. Only children with well-controlled seizures should consider high diving

Bicycling

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. Despite the dangers, children with epilepsy can learn to ride and enjoy bicycles. Because most serious bicycle injuries involve the head, everyone who rides a bicycle should wear a helmet. If the seizures are under control or do not impair motor control or consciousness, bicycle riding should be unrestricted. When the seizures pose a danger, bicycles can be ridden in a park or other place where there are no 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

Horseback riding can be safe and fun for children whose seizures are well controlled or always preceded by an adequate 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

Contact sports such as football, basketball, soccer, rugby, and ice hockey are generally safe for children with epilepsy. The principal 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, however, with a child who has occasional or even frequent seizures playing touch football in the back yard. The risks must be weighed against the benefits of the sport. The chances of serious injury are small compared with the positive effects of team participation.

It would be hard to recommend boxing for any child, and even less for a child with epilepsy. The goal of boxing is to inflict a head injury. 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. Children with epilepsy should avoid boxing, as well as fights with other children. 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. 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.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed: 10/22/03