Objective To investigate the clinical characteristics and treatment of idiopathic and symptomatic occipital lobe epilepsy in children. Methods The clinical data of children with occipital lobe epilepsy diagnosed from April 2013 to April 2022 were retrospectively analyzed. The patients were divided into idiopathic group (including early-onset group and late-onset group) and symptomatic group. The clinical characteristics, auxiliary examination results and treatment were compared between the groups. Results A total of 80 children (28 girls and 52 boys) with occipital lobe epilepsy were included. The median age of onset was 7.0 (5.0-7.0) years old and the median course of disease was 1.7 (1.0-2.5) years. There were 38 children in the early-onset group, 24 in the late-onset group and 18 in the symptomatic group. The age of onset, the proportion of head eye deflection, autonomic nervous symptoms, visual hallucinations, eye clonus, eyelid flutter and falls, and the proportion of abnormal vision and nervous system positive signs during physical examination existed significant differences among the three groups (P<0.05). The proportion of intelligence test score below normal and head MRI abnormalities, and the incidence of abnormal background, bilateral occipital discharge and eye closure sensitivity in the interictal electroencephalogram (EEG) were significantly different among three groups (P<0.05). There were statistically significant differences in the proportion of antiepileptic therapy, monotherapy and the utilization rate of sodium valproate, levetiracetam and topiramate among the three groups (P<0.05). Conclusions The clinical characteristics of idiopathic and symptomatic occipital lobe epilepsy in children are different. The corresponding treatment plan need to be formulated based on the comprehensive evaluation of clinical seizure forms, head imagings and EEG characteristics.