Dravet syndrome (DS), caused by loss-of-function variants in SCN1A, is classically aggravated by chronic sodium-channel blocker treatment, reflecting impaired interneuron excitability as a core disease mechanism. Cenobamate (CNB) challenges this: adult DS cases with substantial seizure reduction have been reported, while pediatric experience is mixed and includes a small cohort with no responders and frequent worsening. We report a 7-year-old girl with SCN1A-associated DS and severe developmental impairment who showed marked reduction of generalized tonic–clonic seizures (GTCS) and total seizure burden with adjunctive CNB therapy. At maintenance CNB dose, which was added to valproate, clobazam and cannabidiol, a total seizure reduction of 80% was noted. An attempt to taper CNB failed because of marked seizure increase nearly back to the pre-CNB state. When CNB was returned to stable maintenance therapy levels, seizures markedly improved with no GTCS noted since October 2025. In addition, we describe a 17-year adolescent male with DS who had GTCS and daily eyelid myoclonia. He achieved suppression of seizures on low-dose CNB (50 mg/day), with only one breakthrough GTCS secondary to a missed evening medication and no reported adverse effects. Taken together with prior pediatric reports, these cases highlight the need for controlled studies to balance potential efficacy against the risk of seizure worsening when considering cenobamate in pediatric DS.