Background Vagus nerve stimulation (VNS), an alternative method to manage patients with medically intractable epilepsy, has shown favorable results in reducing seizure frequency and improvements in quality of life [1]. As the only peripheral branch of the vagus nerve, the auricular branch of vagus nerve (ABVN) innervates the auricular concha in the surface of the body. It is suggested to treat epilepsy via stimulating the ABVN [2]. Objective The present study is to investigate the safety and efficacy of transcutaneous auricular vagus nerve stimulation (ta-VNS) on pediatric patients with epilepsy. Methods Patients were enrolled from the Xuanwu Hospital and Tiantan hospital affiliated to the Capital Medical University. The ta-VNS was performed at the left auricular concha by using of a ta-VNS instrument. Patients or their caregiver were required to keep a detailed seizure diary. Classification of epileptic syndrome, seizure patterns, age of onset, seizure frequency and adverse effects were recorded. The baseline seizure frequency and the seizure frequency after 8 weeks, 16 weeks and 24 weeks of ta-VNS treatment were counted according to patient’s seizure diary. All procedures accorded with the principles of the World Medical Association’s Declaration of Helsinki. Results One patient aborted the study for ineffective reason after 8 weeks treatment. The remained thirteen patients completed the study for the whole 24 weeks without any changes in medication. After 8 weeks ta-VNS treatment, three patients had seizure free (classified as I), one patient has a seizure frequency reduction of more than 90% (classified as III), 10 patients had seizure frequency reductions of less than 50% (classified as IV). After 16 weeks ta-VNS treatment, four patients had seizure free (classified as I), one patient has a seizure frequency reduction of more than 90% (classified as II), two patients has seizure frequency reductions of more than 50% (classified as III), six patients had seizure frequency reductions of less than 50% (classified as IV). After 24 weeks ta-VNS treatment, four patients had seizure free (classified as I), one patient has a seizure frequency reduction of more than 90% (classified as II), two patients has seizure frequency reductions of more than 50% (classified as III), six patients had seizure frequency reductions of less than 50% (classified as IV). Conclusion Our results suggest that ta-VNS is a safe and effective alternative method for pediatric patients.