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Pediatric Stroke

It’s a myth that only older adults have strokes. Stroke can happen to anyone at any time, including teenagers, children, newborns, and unborn babies. The risk of stroke in children is greatest in the first year of life and during the period of right before birth to right after birth. Stroke remains among the top 10 causes of death in children.

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Common Risk Factors

Stroke happens in about 1 in 4,000 live births. The risk of stroke from birth through age 18 is almost 11 in 100,000 children per year. Strokes are slightly more common in children under age 2. Boys and African-American children are at a higher risk for stroke than other groups.

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

  • Congenital heart defects
  • Sickle-cell disease
  • Immune disorders
  • Diseases of the arteries
  • Abnormal blood clotting
  • Head or neck trauma
  • Maternal history of infertility
  • Maternal infection in the fluid surrounding an unborn baby
  • Premature rupture of membrane during pregnancy
  • Pregnancy related high blood pressure in the mother         

Unique Symptoms

Because people do not think about newborns and children having strokes, they are not often recognized or treated properly. Another challenge with newborns is that they cannot communicate symptoms that are not readily visible.

The common stroke warning signs—FAST—used to identify stroke in adults can also be used to identify strokes in children.  But, there are some specific symptoms that you should look for in children depending on their age.

In newborns and infants

  • Seizures.
  • Extreme sleepiness.
  • Tendency to use only one side of their body.

In children and teens

  • Severe headaches
  • Vomiting
  • Sleepiness
  • Dizziness
  • Loss of balance or coordination

Treatment

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

Treatment for pediatric 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 ischemic strokes for adults is tPA, or tissue plasminogen activator, a drug that dissolves blood clots.

With children under 18, use of tPA is controversial and currently limited to clinical trials. Further studies on safety and benefits of this treatment are necessary. Rehabilitation methods with pediatric stroke survivors are also not clear and require further clinical trials.

Current 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.
  • Blood transfusions for children with sickle-cell disease.
  • 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.

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