Objective To investigate the current status of physical activity levels among children and adolescents with epilepsy and analyze the influencing factors. Methods A convenience sampling method was used to survey 60 children and adolescents with epilepsy who visited the Epilepsy Center of Shanghai Children's Hospital from May 2023 to September 2023. The International Physical Activity Questionnaire - Short Form was used to assess their physical activity levels. For potential influencing factors, the Montreal Cognitive Assessment Scale, Self - Rating Anxiety Scale, Self - Rating Depression Scale, and Quality of Life Scale for Adolescent Epilepsy Patients were employed for investigation. Demographic data and disease - related information were retrospectively collected from medical records. Results Sixty valid questionnaires were collected. The total physical activity metabolic equivalent of children and adolescents with epilepsy was 1080 (636, 2346) MET-min/week, which was much lower than the standard recommended by the WHO. There were 25 cases (41.7%) with low physical activity level, 23 cases (38.3%) with moderate physical activity level, and 12 cases (20%) with high physical activity level. Uni-variate analysis and ordinal logistic regression analysis showed that the duration of each seizure, attention, and self-rating depression scores of the children were important independent influencing factors for the physical activity level of children and adolescents with epilepsy (P<0.05). Conclusion Children and adolescents with epilepsy have a relatively low level of physical activity. Parents and schools should guide the children to allocate their attention reasonably. Medical staff should help the children actively control the onset of the disease, pay attention to epilepsy comorbid with attention deficit hyperactivity disorder, identify the depressive emotions of children with epilepsy in time, and strengthen the management of physical activities of children and adolescents with epilepsy, so as to promote active physical activities.