Parenting Issues for Women with Epilepsy

Until recently, women with epilepsy were actively discouraged from marrying or having children. Much of the myth and misinformation about epilepsy has been dispelled, but concerns about caring for infants and young children remain not only for the women with epilepsy but for health care providers as well. While adaptations in the routines of daily living may be necessary for some families, most women with epilepsy can safely care for their children.

The most important single factor for women with epilepsy to be successful parents is optimal seizure control. Health care professionals can also assist women with epilepsy and their families in choosing appropriate lifestyle and environmental adaptations. Ideally, the planning process will start prior to conception or very early in pregnancy.

Newborn and Infant Care

Women with epilepsy need to develop a child care plan based on seizure type and frequency, and the availability of support from family members or friends. If appropriate support is not readily available, consider referral to a home health agency, especially in the neonatal period when stress, fatigue and hormonal changes may increase the risk of seizures.

It is common for anticonvulsant blood levels to rise in the postpartum period. Blood levels of anti-epileptic drugs (AEDs) should be monitored closely for the first few months following delivery, to optimize seizure control and avoid medication toxicity.

Counsel women with epilepsy who have frequent seizures, especially those who fall with seizures, to avoid carrying the infant when alone. An “umbrella stroller” for transport, may be helpful. Front or back infant carriers may be hazardous for women with epilepsy who fall during a seizure.

Child care items can be kept on each level of the home, to minimize stair climbing. Infant care activities, such as dressing and diaper changes, can take place on the floor, to decrease the risk of a fall if the parent has a seizure.

Refer the parent to current sources of information on child safety, and encourage use of playpen, safety gates, and child harness to provide a safe environment should the parent have a seizure while caring for the child alone.

Feeding

For most women with epilepsy, breast-feeding is a safe option. All AEDs appear in breast milk, inversely to the degree of maternal plasma protein binding. This results in a relatively low concentration of most AEDs in breast milk, without adverse effects to the infant. However, infants of women with epilepsy who take phenobarbital or primidone may occasionally be irritable or sedated, and supplemental bottle feedings may be indicated.

It is often easier for women with epilepsy to keep the infant at the bedside and enlist family help for night feedings, to avoid excessive sleep deprivation. If the mother is bottle feeding, suggest that the infant be left in the crib while the mother goes to the kitchen for bottle preparation. Bottle feeding and meals of solid foods can take place with the infant securely strapped into a high chair or in an infant seat on the floor.

Bathing

An infant or young child should be bathed in a tub only if another family member or friend is present. If the mother is alone with her baby, encourage sponge baths, on the floor, with a separate container of water.

Care of Toddlers and Older Children

Much information is available for any parent about child-proofing the home. There may be specific concerns for women with epilepsy, depending on the type and frequency of seizures.

Provide counsel for appropriate safety measures on environmental hazards, including electrical outlets, cabinet access, locked doors to the outside, and secure medication storage.

If the mother has frequent seizures, cooking and other potentially hazardous activities such as ironing should be avoided until another adult family member or friend is present.

Using a stroller, child harness, or wrist bungee cord, especially when traveling, is recommended if the mother has seizures that involve loss of consciousness and child might wander if not restrained.

When the woman with epilepsy is toilet training her child, endorse use of “potty chair,” rather than child booster seat on toilet.

Child Education about Seizures

• Encourage age-appropriate facts about the parent’s seizure disorder.
• Reinforce “seizure drill” safety measures on first aid for the parent during a seizure, and calling for assistance.
• Refer for counseling if seizures cause anxiety or impaired coping skills for family members.

Contact

For additional information, contact the Women and Epilepsy Initiative of the Epilepsy Foundation at (800) 332-4050.

References

Lannon SL. Epilepsy, pregnancy and parenting. Seizure. 1994;3(2):85-93.

Stalland N, Shafer PO. When the parent has epilepsy. In: Santilli N, ed. Managing Seizure Disorders. Philadelphia: Lippincott-Raven Publishers; 1996:189-197.