School well-being in children with epilepsy and febrile seizures: A Danish nationwide cohort study

Background: Seizure disorders, including epilepsy and febrile seizures, affect around 5% of all children in Western countries. Although these conditions may be associated with psychosocial challenges, their impact on school well-being remains unclear. We examined the association of childhood epilepsy and febrile seizures with school well-being. Methods: We conducted a register-based cohort study including children born in Denmark (2000–2014) who participated in the Danish National Well-being Survey (2015–2022) [a survey mandated by law in all public mainstream schools in Denmark]. Children with epilepsy and febrile seizures were matched (1:10) by age and sex to unaffected children. Children with epilepsy and febrile seizures were identified from hospital contacts and antiseizure medication use. Poor school well-being was defined using systematic survey data. Adjusted odds ratios (aORs) with 95% CIs were estimated using logistic regression. Results: Among 770,988 eligible children, 6,862 (0.9%) had epilepsy and 30,851 (4.0%) had febrile seizures, matched to 68,620 and 308,510 unaffected peers, respectively. Among children with epilepsy, 7% of assessments in grades 0–3 indicated poor overall well-being versus 6% in matched peers (aOR, 1.12; 95% CI, 0.99–1.28). In grades 4–9, 10% versus 8% indicated poor well-being (aOR, 1.18; 95% CI, 1.10–1.27), and the association was strongest for academic well-being (aOR, 1.35; 95% CI, 1.27–1.43). Children with febrile seizures had odds of poor well-being similar to their matched peers. Conclusion: Childhood epilepsy was associated with marginally poorer school well-being, although more pronounced in later grades and academic domains, underscoring the need for educational and psychosocial support. Febrile seizures were not associated with poor well-being, providing reassurance for affected children and their families.