Few other joys equal those of parenthood, and epilepsy should not be viewed as a restriction on becoming a parent. Early in the 20th century, many states had laws against marriage and parenthood for persons with epilepsy, but all these prohibitions have been repealed. There are no legal barriers between epilepsy and parenthood, except for those associated with custody suits.

Parenthood is not for every person or couple, however. Becoming a parent is a major commitment of time and resources. The responsibility of caring for a child is difficult to understand before the child is born. A baby is completely dependent on its parents or caregivers for food, clothing, diaper changing, and protection. Caring for a child can be as frustrating as it is joyful.

Caring for infants and children

Caring for a baby or child means loss of freedom and personal time, as well as a new sense of responsibility. The maternal and paternal instincts are strong. After having made it through the potential hazards of a pregnancy with epilepsy, the parents may sigh with relief, feeling that the dangers of epilepsy have passed. Persons with well-controlled epilepsy have no restrictions on child care, but those with episodes of impaired consciousness or control of movement must take special precautions when caring for a baby or a young child. The precautions will depend on the child's age, its nature, and other circumstances.

If at all possible, a parent with uncontrolled seizures should not bathe the baby alone. The baby should be placed in a safely designed baby bath and transferred to and from the bath relatively close to the floor. If the baby bath is placed inside a larger tub, the drain should be open. The room where the bath is given should be carpeted if possible. The parent should always heed an aura, or warning, of a seizure while bathing the baby.

A parent with uncontrolled seizures should be extremely careful when carrying the baby. That is not to say that persons with epilepsy should not carry a baby, but care must be exercised. Some get enough warning of a seizure that they have time to place the baby in a safe place. Others have no warning, and must be especially careful when caring for a baby. Breast-feeding and diaper changing by women who are at risk of having a seizure are best done on the floor or on a low, soft surface where the baby would be safe from falling.

The baby or young child of a parent who has epilepsy is better off sleeping in its own crib or bed. There is a chance the child could be injured if the parent had a seizure, especially a tonic-clonic seizure, while sleeping.

As the baby becomes a toddler, other potential dangers confront a parent whose seizures are not fully controlled. For example, walking or playing near a busy street with an impulsive, active 2-year-old could be potentially dangerous if the parent had a complex partial seizure. During the minute or two of the parent's impaired consciousness, the child's ball could bounce into the street and the child might run after it. Although events such as this are rare, it is worthwhile to consider ways of reducing the risk. In this case, the child might be given another toy that is less likely to bounce into the street, or the child's hand and the parent's hand might be linked by a colorful plastic coil that will keep them close together.

If a parent's seizures are not fully controlled, the disorder should be discussed with older children. Children understand more than adults give them credit for, and they may be aware of the seizures and frightened by them. Explaining to the children what a seizure is, why the parent takes medication, and why the children should not worry is comforting to them. As the children get older, they should be told more about epilepsy and what to do if first aid is needed.

Missed medications, sleep deprivation, and stress can aggravate seizures. For new parents, some sleep deprivation and stress are unavoidable, and dramatic changes in the daily schedule can easily lead to missed medications. It is important to recognize these potential problems and plan to reduce their impact. A mother with epilepsy who chooses to breastfeed, for example, might want to use a formula supplement so that she can sleep while her husband or another person feeds the baby during the night. Caring for a baby is stressful and exhausting, and enlisting family members or others to help is a good idea.

Breastfeeding

Breast feeding is recommended for most women with epilepsy, because breast milk confers a variety of benefits to the baby, including protection against infection. However, the benefits of breastfeeding must be weighed against the risks when the mother takes antiepileptic drugs.

The table below shows the approximate percentages of the mother's blood drug level found in breast milk. The amount of drug found in breast milk is related to the proportion of the drug that is not bound to proteins. The more a drug is bound to proteins in the blood, the lower the amount that is free and the lower the amount found in breast milk.

Phenobarbital and primidone, both barbiturates, cause the most problems with breastfeeding. The baby's digestive system is particularly good at absorbing these drugs, and they linger for an unusually long time in the baby's blood. A single dose of phenobarbital may last more than 15 days. Because of the high amount of ethosuximide, gabapentin, and levetiracetam found in breast milk, these may also cause problems. The antiepileptic drugs in babies who are breastfed may cause fussy feeding habits, sleepiness, and irritability. Some irritability and gas pains are normal, however, and should not be interpreted as medication effects. The mother should contact the pediatrician if she has any doubts.

If a breastfeeding woman takes two antiepileptic drugs, or takes barbiturates or ethosuximide, the baby should be watched closely for signs of adverse reactions to the drugs. The baby of a woman who breast-feeds and then stops taking a barbiturate should be observed for signs of drug withdrawal such as increased irritability, insomnia, or sweating. If these signs are observed, the pediatrician should be contacted.

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed: 12/15/06