AimTo assess the effectiveness and tolerability of lacosamide in paediatric clinical practice.MethodsA search of our hospital's pharmacy database yielded all children <16 years old dispensed lacosamide for drug‐resistant epilepsy between January 2011 and June 2016. Medical records were reviewed for clinical and drug details. Continued treatment for ≥12 months was considered an indicator of effectiveness and tolerability.ResultsA total of 107 children (61 boys) satisfied inclusion criteria. Median age at lacosamide commencement was 9.9 years (interquartile range 6.7–13.7). Of those children, 57 (53%) children had focal epilepsy, with focal motor or impaired awareness seizures most commonly reported; 50 (47%) children had generalised epilepsy, most with tonic–clonic seizures, tonic seizures or epileptic spasms; 83 (78%) children had an intellectual disability, 24 (22%) had a physical disability and 22 (21%) had an autism spectrum disorder; 69 (65%) children continued lacosamide for ≥12 months. Reasons for discontinuation before 12 months in 38 (35%) children included ineffectiveness in 25 (66%), adverse events in 7 (18%) and worsening of seizures in 2 (5%). The most common adverse events were drowsiness, behavioural changes, unsteadiness, nausea and vomiting. Epilepsy type and comorbidities were not associated with continuation or reasons for discontinuation.ConclusionsMost children continued treatment with lacosamide, suggesting effectiveness and tolerability. Lacosamide may prove to be a useful, ‘broad‐spectrum’ antiepileptic medication in children for focal and generalised epilepsies and in association with comorbidities.