In our large population-based cohort, 3.1% of adults had seizures within the first 24 h of acute stroke. The objective of our study was to determine a similar incidence in children and compare by stroke subtype. Stroke cases in children between July 1993 to June 1994 and January 1999 to December 1999 were retrospectively identified and abstracted. We identified 31 strokes during the two study periods, including 17 ischemic strokes, 12 intracerebral hemorrhages, and 2 subarachnoid hemorrhages. Seizures occurred within 24 h of the stroke in 58% (18/31) of children. No significant differences were found in the rate of seizure by stroke subtype. The relative risk (95% confidence interval) for seizure in the acute stroke setting in children versus adults is 18 (13, 26). As compared with adults, seizures within the acute setting of childhood stroke are common with an occurrence rate in our population of 58%. © 2009 Sage Publications.