Pediatric Stroke 101

Please see our Fact Sheets page for shareable information.

Defining Pediatric Stroke

Perinatal Stroke: Last 18 weeks of gestation through 1-month old
Childhood Stroke: 1-month old to 18 years

Pediatric Stroke Statistics

There is no universal surveillance for this population

  • The prevalence of Perinatal Stroke is 1 in 4,000 live births (AHA 2019 Journal)
  • Incidence of Perinatal Stroke may be as high as 1 in 1,000 live births (Canada)
  • The annual incidence of Childhood Stroke ranges from 3 to 25 per 100,000 children (AHA 2019 Journal)
  • Affects 5 out of 100,000 children per year in the UK (combines perinatal with childhood stroke)
  • In Canada there are more than 10,000 children (0 – 18 years) living with stroke

The majority of pediatric strokes occur in the perinatal period.

 Facts at a Glance

  • Delays in diagnosis are common in both perinatal and childhood stroke, but for different reasons.
  • Seizures at stroke onset are more common in children than adults.
  • Stoke is among the top 12 causes of death between the ages of one and 19.
  • Of children surviving stroke, about 60% will have permanent neurological deficits, most commonly hemiparesis or hemiplegia. Hemiplegia is the most common form of cerebral palsy in children born at term, and stroke is its leading cause.
  • Other long-term disabilities caused by a stroke in childhood can include cognitive and sensory impairments, epilepsy, speech or communication disorder, visual disturbances, poor attention, and behavioral problems.
  • Black and Asian children have a higher incidence of stroke than white children.
  • Incidence rates vary, but the highest rate is in children under 5, and higher in boys than girls.

Some of the Risk Factors 

Perinatal

  • Congenital heart disease
  • Disorders of the placenta
  • Blood clotting disorders
  • Infections
  • Maternal disorders

In most perinatal strokes, no risk factors are ever found.

Childhood

  • Congenital heart disease
  • Cardiac disorders
  • Cerebral vascular disorders
  • Infections
  • Head or neck trauma
  • Sickle cell disease
  • Autoimmune disorders

No previous risk factors are identified in about half of childhood stroke cases.

Key Points

Perinatal

  • The most common type of stroke in the perinatal period is ischemic stroke.
  • After a perinatal stroke, the risk of another stroke is very low — less than 1%.
  • Perinatal strokes are often missed because the signs and symptoms are subtle.
  • Many infants do not show any signs of stroke until they are 5 months or older.
  • Currently, there is no established immediate treatment for perinatal stroke.
  • Intervention during the first few years of life (while the brain has the most plasticity) could improve the outcome after perinatal stroke.
  • Infants with early hand preference before 12 months should see their pediatrician and request a referral to a pediatric neurologist to rule out anything neurological.

Childhood

  • Childhood strokes may be missed because there is a lack of awareness that children can indeed have a stroke.
  • Delays in seeking medical care, confirming diagnosis, and accessing an MRI can be 24 hours or more.
  • Incidence rates vary, but the highest rate is in children under 5, and higher in boys than girls.
  • Many children with stroke symptoms are misdiagnosed with the more common conditions that stroke can mimic such as migraines with aura, seizures, or Bell’s Palsy.
  • In older children, the signs and symptoms of stroke are very similar to those in adults and depend upon the area of the brain involved.
  • To date, the use of tPA (a clot- busting treatment) and thrombectomy (clot retrieval procedure) are not currently FDA approved for children in the U.S. These treatments have been used in some children, but more research is needed.
  • Early recognition and treatment during the first hours and days after a stroke is important to optimize outcome.

List of Specialists

Cardiologists — specialize in diagnosing and treating heart problems in children
Case Managers — work for social service agencies and medical facilities, where they provide counseling and coordinate treatment plans for children and teens
Developmental Pediatricians — highly trained and experienced in identifying a range of developmental and behavioral differences in children
Epileptologists — experts in epileptic seizures and seizure disorders, anticonvulsants, and special situations involving seizures
Genetic Counselors — inform and advise individuals and families on their risk for inheriting certain diseases and the treatment options available
Hematologists — a blood specialist who helps with testing for blood clotting disorders
Neonatologists — a pediatrician expert in newborn care is usually involved early in the care of children diagnosed with acute neonatal strokes
Neuro-Ophthalmologists — specialize in visual problems related to the nervous system, including loss of sight due to injury to the brain or the optic nerves which transmit visual signals from the eyes to the brain
Neuropsychologists — for assessment and help with learning and education needs
Neurosurgeons — occasionally involved when certain types of stroke can be helped with surgical procedures
Occupational Therapists — works with the child to enhance participation in everyday activities, play and sports, and return to home or school
Orthotists — healthcare professional who makes and fits braces and splints (orthoses) for people who need added support for body parts that have been weakened by injury, disease, or disorders of the nerves, muscles, or bones
Pediatric Neurologists – doctors that deal with the diagnosis and management of neurological conditions in neonates (newborns), infants, children, and adolescents.
Pediatric Ophthalmologists — a medical and surgical doctor who specializes in the care of children’s eyes
Pediatric Orthopedic Surgeons — expert in the “mechanical” complications of stroke such as tightness in the arm or leg that might be helped by surgery
Physiatrists – doctors who specialize in physical medicine and rehabilitation
Physical Therapists — assists in reaching the child’s maximum potential to function, facilitates motor development, improves strength and endurance
Social Workers – provides services to advise family care givers, providing patient education and counseling, and makes referrals for other services
Speech-Language Pathologists — for assessment and help with speech or language challenges

Definitions and FAQs

Glossary of Pediatric Stroke Terms from Children’s Hospital of Philadelphia
Summary of pediatric stroke terms and signs and symptoms. Includes fact sheet and video. 2019

Pediatric Stroke: Definitions and Terminology
From the University of Calgary, Calgary Pediatric Stroke Program. 2019

Frequently Asked Questions on Perinatal Stroke
From the University of Calgary, Calgary Pediatric Stroke Program