Use of medication with a desired effect on the central nervous system (as with anti-epileptic drugs) in children will undoubtedly cause concern about neurodevelopment. Data are emerging to suggest an effect of anticonvulsants on the developing brain of the unborn child when administered to mothers with epilepsy. This obviously requires detailed evaluation, especially when considering the risks of epilepsy itself. In the child with epilepsy, many of the early onset epilepsies are associated with developmental compromise as part of their clinical profile, and therefore determining the relative effects of the underlying cause, seizures and medication can be difficult. Although data are available with regard to some anti-epileptic drugs (AEDs) they remain lacking particularly in the very young with regard to efficacy as well as neurodevelopmental effects of the newer anti-epileptic drugs. Ongoing evaluation is required to ensure the best clinical practice in each individual.