Objective To understand the path of family adaptation status and influencing factors among primary caregivers of children with epilepsy, so as to provide reference for conducting targeted nursing intervention.Methods From January to July 2024, a total of 335 primary caregivers of children with epilepsy were selected from the outpatient and inpatient departments of neurology in a Grade A children′s hospital by convenience sampling method, then they were investigated by using the Family Ritual Questionnaire, the Family Adaptability and Cohesion Evaluation Scales, the Family Hardiness Index and the Family Adaptation Scale.Results The participants′ score of family adaptation was （72.37±16.27）, and it was positively correlated with family ritual, family cohesion and family hardiness （all P＜0.05）.Family ritual had a direct positive effect on family adaptation of the primary caregi-vers of children with epilepsy, and family cohesion and family hardiness had a significant chain mediation effect between family ri-tual and family adaptation （all P＜0.05）.Conclusion The family adaptation in the primary caregivers of children with epilepsy is at a medium and above level.Medical staff should pay attention to the improvement of family structure and function, help the primary caregivers to enhance the family cohesion and hardiness to improve the family adaptation level.