Background <p>Although physical activity is essential for managing epilepsy, children with epilepsy often have low activity levels. It is important to identify the barriers and facilitators to increasing physical activity from the perspectives of both children and their caregivers.</p> Methods <p>Semi-structured interviews were conducted with 12 children with epilepsy and their caregivers in Chongqing, China, from April to July 2024. The transcriptions were analyzed thematically using an inductive descriptive method. None of the children with epilepsy had contraindications to physical activity. Four participants had drug-resistant epilepsy.</p> Results <p>Four barriers and four facilitators to physical activity were identified from the interviews. The four themes of barriers are physical burden, psychological barriers, limited knowledge, and social exclusion. Children with epilepsy experienced physical and psychological barriers such as limited mobility, sleep disturbances, chronic fatigue, stigma, and seizure anxiety. Lack of knowledge makes children with epilepsy suffer from excessive restrictions in physical activity. The four facilitator themes are the perceived benefits of physical activity, support from healthcare providers, support from family, and support from peers.</p> Conclusions <p>Healthcare providers should pay attention to the physical activity needs of children with epilepsy, correct misconceptions about physical activity among children and their caregivers, and increase awareness of physical activity through education. Improving societal attitudes, along with encouraging family involvement and peer support, can significantly increase engagement in physical activity and improve overall physical and mental well-being.</p>