An expanding array of antiepileptic drugs (AEDs) is available to treat childhood epilepsy, offering the potential for improved seizure control and quality of life in this important patient population but also providing challenges in the selection of the best regimen for the individual patient. In addition to correct diagnosis of seizure type and general AED efficacy profile, other important treatment considerations in pediatric patients include age-specific organ toxicity, potential cognitive and behavioral or psychiatric effects of AEDs, compliance, and drug-drug interactions, since children commonly receive more medications than nonelderly adults. Drug dosing may be more difficult in pediatric than in adult epilepsy patients, and doses in children often require adjustment as the patient matures. Because many randomized controlled trials (RCTs) of newer AEDs have not included childhood epilepsy, physicians often have incomplete data on which to base treatment decisions. Therefore, despite the wider array of potential therapies, it is often unclear how to realize the potential they offer. Recently published guidelines from a number of organizations have provided strategies for the use of new AEDs in the treatment of childhood epilepsy. Additional RCTs of monotherapy options for childhood epilepsy are greatly needed. The ketogenic diet provides an alternative to pharmacologic control of seizures in some pediatric patients.