It’s a myth that only older adults have strokes. While people over 65 are at higher risk of stroke, a person of any age can have a stroke, including teenagers, children, newborns and unborn babies. Although estimates vary, stroke affects about 6 in 100,000 children. Stroke is a leading cause of death in children in the U.S.

Adult Versus Pediatric Stroke

Stroke is different in children and newborns than it is in adults. Children have hemorrhagic strokes as often as they have ischemic strokes, while adults are more likely to have ischemic strokes. Sixty percent of pediatric strokes occur in boys. Causes of stroke are also different in children than they are in adults.

Risk Factors

While high blood pressure, an irregular heartbeat (atrial fibrillation) and a hardening of the arteries (atherosclerosis) are common causes of adult strokes, they are rare in children. Common risk factors for stroke in children include:

Diseases of the arteries
Cardiac disorders
Infection
Acute or chronic head and neck disorders
Abnormal blood clotting
Sickle-cell disease

A recent study reported an increase over the past 13 years in traditional cardiovascular risk factors for stroke in people ages 15-34. The main risk factors that are increasing in the younger population are high blood pressure, diabetes, obesity, cholesterol-related disorders, tobacco use and alcohol abuse.

Symptoms

Because people do not think about newborns and children having strokes, they may not associate a child’s symptoms with stroke and consequently, the child may not receive proper treatment. Another challenge with newborns is that they cannot communicate symptoms that are not readily visible. If the symptoms and warning signs used to identify stroke in adults are present in children and newborns, call 9-1-1. Some other symptoms that may indicate pediatric stroke are:

Seizures, especially in newborns
Worsening or sudden headaches
Sudden difficulty speaking, slurring of words or trouble understanding speech
Hemiparesis, or a weakness on one side of the body
Sudden loss of vision or abnormal eye movements
Sudden loss of balance or trouble walking

Treatment

Treatment for pediatric stroke, as with adult stroke, depends on the specific cause. Some common treatments used with adults are not appropriate for young children and infants.

One of the best treatments for adults is tPA, administered within three hours of when symptoms begin. tPA, or tissue plasminogen activator, is a drug that dissolves blood clots and is a common and effective treatment in adults with ischemic strokes. With children under 15, use of tPA is controversial because of physiological differences between children and adults and is being studied further.

Antithrombotic therapy, which refers to medications used to prevent blood clots from forming or growing, is used in children but generally not infants. Surgery related to hemorrhagic stroke (and less commonly, ischemic stroke) is sometimes performed to relieve pressure on the brain.

Common treatments for pediatric stroke include:

Supportive care to maintain normal body temperature, proper hydration and normal blood sugar levels
Controlling high blood pressure
Detecting and treating seizures with EEG monitoring and anticonvulsant medication
Managing intracranial pressure

Effects

Each person experiences stroke differently, but typically, children experience the same effects as adults do. The most common effects are:

Hemiparesis, or weakness on one side of the body
Hemiplegia, or paralysis on one side of the body
One-sided neglect, or ignoring the weaker side
Aphasia, or difficulty with speech and language
Dysphagia, or trouble swallowing
Vision problems
Changes in mood
Cognitive changes, or problems with memory, judgment and problem solving
Behavior or personality changes

Other effects include:

Seizures
Epilepsy
Cerebral palsy

The left hemisphere of the brain controls the movement of the right side of the body, plus speech and language. A child who has a stroke on the left side of the brain may have trouble moving the right side of his body and may have difficulty reading or talking.

The right hemisphere of the brain controls the movement of the left side of the body, plus analytical and perceptual tasks, such as judging distance, size, speed or position. A child who has a stroke on the left side of the brain may have trouble moving the left side of his body and doing things such as buttoning a shirt or tying shoes.

Management

Children usually recover better than adults do because their brains are still growing.However, children can experience permanent complications from stroke, such as seizures, weakness and vision problems.

Seizures are closely related to pediatric stroke and can become a continuing issue after a stroke. About 15 percent of seizures in newborns are secondary to stroke. In general, risk of recurrent pediatric stroke is low. However, children who have seizures often have a greater difficulty recovering.

Sickle Cell Disease

Sickle-cell disease (SCD) is an inherited disorder in which red blood cells take on an abnormal shape. Stroke is a major complication of SCD. Children with SCD are much more likely to have a stroke than are children in general. Also, the risk of recurrent stroke in infants and children with untreated SCD is much higher—as high as 90 percent, according to some studies. A doctor can run tests to get a better understanding of the risk of stroke in a child with SCD. Regular red blood cell transfusion has been shown to reduce stroke risk in people with SCD.

Additional Resources

Publications

Fact Sheets

Multimedia

Children's Hemiplegia and Stroke Association

Photo of Bailey

» Read more about Bailey’s experience.

Faces of Stroke Logo

Acting FAST at the first sign of a stroke can help a person receive an accurate diagnosis. This is especially challenging among children and teens, because few know that stroke can happen at any age despite being among the top 10 causes of death in children in the U.S.

Bailey Carlson, 18, is a teenage stroke survivor from Minnesota and a Faces of Stroke Ambassador who cares about spreading the word about how to recognize warning signs. Bailey’s stroke symptoms were dismissed as stress and it took some time to receive an accurate diagnosis so treatment could begin.