Objective <p>Rotavirus remains a leading global cause of acute gastroenteritis. Although most affected children fully recover, neurological complications may occur. This study evaluated the frequency of neurological complications in pediatric patients at our center and assessed their developmental trajectories and long-term outcomes.</p> Methods <p>We retrospectively analyzed 398 patients (0–18 years) with clinically diagnosed gastroenteritis and stool-confirmed rotavirus infection, evaluated between February 2017 and September 2023 at the pediatric inpatient and outpatient clinics of the University of Health Sciences, Gülhane Training and Research Hospital.</p> Results <p>Acute neurological complications occurred in 1.5% (6/398), with seizures being the only observed manifestation (four febrile, two afebrile). Electroencephalography (EEG) was performed in three patients and was normal in two; one showed bilateral frontotemporal spike-wave discharges. Brain magnetic resonance imaging (MRI) was conducted in three patients, all of whom had normal findings, none underwent cerebrospinal fluid (CSF) analysis. One child developed persistent unilateral (40%) hearing loss after the episode. During follow-up, three patients were diagnosed with epilepsy. Median follow-up was 33 months (16–94). Across the cohort, 11.3% had speech problems; 0.5% autism spectrum disorder (ASD), 0.5% specific learning disability, and 0.3% attention-deficit/hyperactivity disorder (ADHD) in follow up. Gross motor development was normal in all; fine motor delay occurred in 0.7%.</p> Conclusions <p>Seizures are the most common neurological complication of rotavirus gastroenteritis. Although typically benign in young children, these events may increase the risk of subsequent epilepsy. Other complications, including hearing loss, should also be considered. Vaccination remains an effective strategy to reduce complication rates.</p>