There are over 400 childhood strokes a year in the UK. A stroke occurring at any time from 29 days old up to the age of 18 is classed as a childhood stroke. The causes and the effects of a stroke are likely to be different depending on how old the child is.
A stroke happens when the blood supply to part of the brain is cut off. There are two main types of stroke:
- Ischaemic strokes are caused by a blockage in the blood supply to the brain.
- Haemorrhagic strokes occur when blood leaks from a burst blood vessel into the brain.
Both types of stroke are equally common in children, but in adults 85% of strokes are ischaemic.
Children can also have a transient ischaemic attack (TIA), which happens when the brain's blood supply is interrupted for a very brief time. The symptoms only last for a few minutes or hours and then completely disappear, usually within 24 hours.
Stroke in babies (during pregnancy to within 28 days after birth) can be caused by clots breaking off from the placenta and lodging in the child’s brain. Or because of a blood clotting disorder that the mother or baby may have.
Strokes in children from 29 days to 18-years-old are often associated with existing conditions, most commonly congenital heart disease and sickle cell disease (SCD). Other risk factors are:
- infectious diseases
- trauma to the head or neck
- vascular problems
- blood disorders.
In many cases of childhood stroke, there's more than one risk factor. Stroke can also affect previously healthy children and in some cases, there can be no apparent cause.
Stroke is a medical emergency and you must call 999 immediately if your child is displaying stroke-like symptoms. At the hospital, your child should see a consultant paediatrician, neurosurgeon or paediatric neurologist.
A brain scan should take place as soon as possible to confirm whether your child has had a stroke. There are two types of scans:
- MRI - An MRI scan is preferable as it shows a more detailed image of the affected area and blood vessels within the brain. This should last an hour and requires your child lying still while the machine takes a picture of their brain. Your child may be given a sedative to help keep them still.
- CT - If an MRI scan isn't available, a CT scan is a good alternative.
New clinical guidelines
Families have told that us that too few professionals know that stroke can occur in children, meaning that it can take a long time to get a diagnosis and the long-term support they need.
That’s why we have supported the Royal College of Paediatric and Child Health (RCPCH) to develop new clinical guidelines for childhood stroke. The guidelines, which will push up the standard of care, clearly state:
- The FAST test should be used to diagnose a stroke in children.
- A brain scan should be carried out within one hour of admission for every child with a suspected stroke.
- Rehabilitation should be discussed at the point of diagnosis and should continue for as long as the child needs it.
A version for parents and families (also available in Welsh) has also been produced, which highlights the different types of stroke, the signs, and the potential effects. If your child has had a stroke, we also offer a range of resources and support.
This work would not have been possible without the generosity of our supporters and, in particular, The Thompson Family Charitable Trust.
There is also an algorithm poster to accompany the clinical guideline – providing the user with the suggested pathway to identify and treat a childhood stroke.
Once the doctor knows what type of stroke the child has had, they'll be able to decide the best treatment. If the stroke was caused by a blockage, long-term blood-thinning medication, like aspirin, may be prescribed to help prevent another stroke from happening.
If your child has sickle cell disease, they'll have an urgent blood transfusion. The transfusion will help replace the sickled red blood cells in your child's body with normal blood cells.
Once your child is well enough, rehabilitation should begin. Many people believe children fully recover after stroke because their brain is still developing but it's more accurate to say that children are better at adapting to the effects of stroke.
Needs after stroke in childhood: research study update
As part of the Childhood Stroke Project we carried out a multi-centre research study to identify the needs of children, young people and their families following stroke in childhood. You can read a summary of the key findings of the research.