Epilepsy is one of the most common chronic neurological disorders in children, with a prevalence of 0.4% to 0.7% For most children with epilepsy, oral antiepileptic medication for epilepsy is usually the preferred treatment option. Many clinicians have the following question: Is it necessary to start antiepileptic therapy immediately after the first seizure? Studies have shown that starting AEDs immediately after the first seizure does reduce the risk of recurrent seizures by 34% (15% to 52%), but has no effect on the patient’s long-term seizure prognosis. Therefore, AEDs can usually be temporarily withheld after the first seizure, but intensive care is needed to avoid unintentional injury. AEDs may be considered after the first seizure if: 1. the first seizure occurs as a persistent status epilepticus; 2. a presumed high likelihood of a second seizure (e.g., structural lesions in the brain); and 3. seizures in public during the waking period may have a physical and psychological impact on the child and affect the older child and parents. AEDs can usually be started after the second seizure, but may be withheld in the following cases: 1. The number of seizures is sparse; 2. Age-dependent self-limiting epilepsy, closer to the self-limiting age; 3. Seizures have no significant impact on the child’s quality of life and parents are temporarily reluctant to put the child on medication. AEDs are usually a longer-term treatment process. Before deciding to start AEDs treatment, the benefits need to be weighed against the risks, and AEDs treatment can be considered when the benefits of treatment > seizure reoccurrence + potential risks of AEDs treatment. The final choice should be made by full communication between the clinician and the child’s family.