Stroke in childhood - information for parents

What is a stroke?

A stroke is caused by sudden interruption of the blood supply to the brain and spinal cord. It affects the body, functions which are normally controlled by the brain and spinal cord; for example, movement and speech. Stroke is an important cause of childhood illnesses. There are two main types of stroke:

1. Ischemic – this is caused by a blockage of the blood supply to an area of the brain.
2. Haemorrhagic – this is caused by blood leaking from blood vessels into an area of the brain.

Both types of stroke cause damage to brain cells. The resulting difficulties experienced by the child depend on which area of the brain is affected.

When a stroke happens, while some of the surrounding brain cells may recover as the swelling and inflammation subsides, other cells and pathways affected by the stroke can be irreversibly damaged. This may have a long term impact on the function they control. The process of recovery from stroke is different for everyone. It can take weeks, months or even years. Rehabilitation plays an essential role in supporting recovery and adaptation.

Almost all children recover some of the lost function during the recovery period. However, the stroke can have a long term impact where function does not fully recover. In these cases, the child and family may need ongoing support to help them manage their new difficulties.

What causes stroke in children?

The causes of ischaemic stroke in children are not the same as in adults, in whom strokes are often associated with lifestyle factors such as smoking and diet.

Blood supply can be interrupted in different ways, causing ‘ischaemic stroke’. Certain infections like chickenpox (known medically as ‘varicella’) can cause a narrowing of the blood vessels, thus reducing blood flow. Certain conditions increase formation of clots that can block blood vessels. In some conditions there is a break in the vessel wall which reduces blood flow and also increase the risk of clot formation.

‘Haemorrhagic stroke’ is caused by bleeding from abnormal vessels which may be especially fragile. In 10% of children, we may not find the exact cause for the stroke despite extensive tests.

What are the signs that a child has had a stroke?

Signs of a stroke vary depending on the child’s age and stage of development. This may be difficult to recognise in a young child.

As with adults, a common symptom of stroke in children is weakness of one side of the body or face (hemiplegia). In some children the stroke may show itself with seizures and weakness, new-onset severe headache, speech difficulties, dizziness, clumsiness, and reduced consciousness.

Are strokes common in children?

In the UK, about five out of every 100,000 children per year have a stroke (a total of several hundred). Ischaemic and haemorrhagic strokes are equally common.

How is healthcare organised for children affected by stroke?

Most children will be admitted to hospital for initial care and assessment. Diagnosing and finding the cause of a stroke will help us to plan your child’s medical treatment. A number of tests may be carried out, for example brain scan, blood tests and echocardiography (ultrasound scan of the heart). Medical, nursing and therapy assessments will also be made to help plan your child’s care.

Immediately after the stroke, your child’s healthcare may be provided in your local hospital with transfer later to a specialist centre. A consultant paediatric neurologist should be involved in or consulted about your child’s care. In the longer term, community child health services will help to co-ordinate services according to your child’s needs. The care team could include doctors, nurses, therapists, teachers, social workers, dietitians, and many other professionals.

Medical and surgical treatment

Treatment will depend on the cause of your child’s stroke as well as how quickly the stroke is diagnosed. Some children are suitable for a ‘clot-busting’ treatment called thrombolysis; this can restore the blood supply to the affected areas of the brain in some ischaemic strokes, although this is done only in specific circumstances. In some cases, a child might be referred to the interventional radiologists or surgeons for treatment. This may be required to treat the cause of the stroke itself, or certain complications.

Drugs that make the blood thinner and therefore less likely to clot (such as aspirin, heparin, or warfarin) may be considered for longer-term treatment of children who have had an ischaemic stroke. Some of these medications require monitoring with blood tests and some may not be suitable in certain medical conditions.

Rehabilitation

Rehabilitation following stroke should begin immediately. In the first few days, assessment of movement and positioning, swallowing, speech and communication will take place. These assessments may involve a number of different health professionals, who will inform the community health team in your local area so that care can continue once your child goes home. We will make sure that you, as parents, are involved in all discussions throughout the journey. There will be meetings between you and the healthcare professionals involved in your child’s care before discharge. In the longer term, rehabilitation may take place in a hospital or rehabilitation unit, or at home with community therapy input. Areas to be considered may include:

1. Improving abilities affected by the stroke; for example, movement, speech and communication.
2. Finding ways of adapting to changes in ability.
3. Developing skills in daily activities such as self-care, leisure, school and play.
4. Social, emotional, and practical support following discharge from hospital.
5. Supporting the return to family life at home and participation in a full range of social, leisure and educational activities.

The exact nature of your child’s rehabilitation will vary according to their needs. Your child will be assessed to see which treatments and therapies are needed to bring about as good a recovery as possible. Returning to school full-time following a stroke will be a major milestone for your child and needs to be carefully planned. A gradual return may be advisable. Keeping in touch with friends during the recovery period can assist your child in settling back into school. The local education authority (LEA) is responsible for planning your child’s return, and you should be a part of this process. Other organisations that can be helpful include the Child Brain Injury Trust and the Stroke Association.

Will the stroke happen again?

This very much depends on the underlying cause of the stroke. Some children, such as those with sickle cell disease, are at relatively higher risk than others. The risk to your child will be considered on an individual basis. Your child’s doctors will be able to discuss this with you.

How can another stroke be prevented?

Various treatments are available which aim to reduce the chances of further stroke. In other children with ischaemic stroke, long-term blood-thinning medication (for example aspirin or warfarin) is recommended. In children with a rare condition called Moyamoya, surgery can sometimes improve the blood flow to the brain. Recommendations will be made according to your child’s underlying condition.

Depending on the underlying condition, specific treatments may be offered to your child. Your doctor will discuss these with you as necessary.

Useful organisations

Stroke Association (opens in a new tab)
Helpline: 0845 303 3100

Child Brain Injury Trust (opens in a new tab)
Helpline: 0303 303 2248

Children’s Hemiplegia and Stroke Association (opens in a new tab)

Contact, the charity for families with disabled children (opens in a new tab)
Freephone: 0808 808 3555

Different Strokes (opens in a new tab)
Helpline: 0845 1307172

Headway – the brain injury association (opens in a new tab)
Helpline: 0808 800 2244