Childhood is a vulnerable time--developmentally, socially, and cognitively. Any disruption may have long-standing effects on the attainment of critical developmental milestones. The impact of ongoing seizures and epilepsy in children is significant and may result in cognitive delay, poorer educational outcomes, and lower employment rates in adulthood. The early recognition, intervention, and treatment of evolving pharmacoresistant epilepsy in children presents a unique opportunities for health care practitioners. Seizure freedom is the ultimate epilepsy treatment goal, given the broad and long-standing effects of seizures in childhood. However, even when we believe the chance of seizure freedom is low, we should not let the perceived unlikelihood of that goal limit the treatments we offer. All children with pharmacoresistant epilepsy should be evaluated at a comprehensive pediatric epilepsy center. Failing to offer state-of-the-art treatments to these children only increases the burden of epilepsy on children and their families.