As the saying goes, “medicine is toxic in three ways”, and antiepileptic drugs are no exception. On the one hand, it can control seizures, but on the other hand, it can also cause some toxic side effects that are harmful to the body. Generally speaking, the antiepileptic drugs chosen by the doctor according to the age, medical history and seizure type of the child are selected after a long period of clinical use, screening and proven to be safe and effective. The toxic side effects of the drugs are mostly mild and reversible. The most common clinical side effects of antiepileptic drugs are cutaneous, with various types of rashes, sometimes with fever and swollen lymph nodes. This can be followed by impaired liver function and decreased blood counts. Some may cause movement disorders, such as limb weakness, unsteady walking, tremor, and chorea, as well as drowsiness, anorexia, and weight changes. There may also be some effects on cognitive function. Adverse drug reactions often occur at the beginning of treatment, such as specific hypersensitivity reactions and gastrointestinal reactions due to antiepileptic drugs, often occurring within 2-8 weeks of starting treatment. Second, they can occur when high doses are applied during rapid drug dose adjustments, even when blood levels are in the therapeutic range. Further, when antiepileptic drugs are applied in combination, adverse drug reactions can also be increased due to drug-drug interactions and altered pharmacodynamics. There is also a genetic susceptibility of the patient, and the condition of the patient before the disease can lead to vulnerability to adverse reactions to a particular antiepileptic drug. Because of the characteristics of epilepsy, medications need to be taken over a long period of time, sometimes in larger doses, and in combination with medications as a last resort, the safety of medications should be taken seriously by both patients and physicians. In order to minimize the occurrence of side effects of antiepileptic drugs, doctors often need to understand the child’s medical history and physical condition in detail, and select drugs that are specific to the type of seizure, but also pay attention to the adverse effects of drugs on the child, so as to achieve maximum efficacy and minimal impact on health and cognition. The physician should also adopt the principle of slow dosing, avoid multiple drug combinations as much as possible, and strengthen the early observation of drug use. For the child and parents, it is especially important to work carefully with the physician during the first few weeks of a new antiepileptic drug, to keep records where possible, to observe drug efficacy and side effects, to note correlations with drug doses and factors affecting them, and to contact the physician in a timely manner. Do not lose confidence in treatment because of early side effects and give up a drug prematurely. Discontinuing medication on your own can often lead to more frequent seizures and make subsequent treatment more difficult. Clinical practice has shown that as long as both parties cooperate well and strengthen the early observation of medication, adverse reactions will be greatly reduced, laying a good foundation for smooth treatment in the future.