Strokes In Small Children: What Are The Risks?

Strokes are rare in small children, but they can happen. A stroke occurs when blood flow to the brain is blocked or interrupted, either by a blood clot or a broken blood vessel. When this happens, brain cells begin to die, and brain damage can occur. This can lead to permanent changes in cognitive function, speech, and vision, as well as physical weakness or paralysis on one side of the body. While stroke symptoms in older children may be similar to those in adults, younger children may exhibit signs such as seizures, developmental delays, and an early preference for using one hand over the other. Prompt medical attention and treatment are crucial for optimizing recovery and minimizing the risk of recurrence.

Risk factors for strokes in small children

Strokes are rare in babies, children, and adolescents, but they do happen. The risk factors for strokes in children are very different from those in adults.

Perinatal Strokes

Perinatal strokes can occur in the last few months of pregnancy up to one month after birth. Risk factors include:

• Congenital heart disease
• Blood clotting disorders
• Infections (e.g., meningitis)
• Premature rupture of membranes
• Gestational diabetes

Childhood Strokes

Childhood strokes can occur between one month old and 18 years old. Risk factors include:

• Congenital heart disease
• Sickle cell disease
• Infectious diseases
• Trauma to the head or neck
• Vascular problems
• Blood disorders
• High blood pressure (hypertension)
• Thrombophilia or hemophilia
• Traumatic brain injury (TBI) or neck injury
• Certain genetic syndromes, e.g., Down syndrome
• Autoimmune disorders

Lifestyle Factors

While these are not specific to small children, it is worth noting that lifestyle choices can also increase the risk of stroke, including:

• A diet high in saturated fats, trans fat, and cholesterol
• Lack of physical activity
• Excessive alcohol consumption
• Tobacco use
• Exposure to secondhand smoke

Signs and symptoms of strokes in small children

Strokes are rare in small children, but they do happen. The symptoms of a stroke in a child are often similar to those in adults, but there are some key differences.

Symptoms of a stroke in infants

Infants who have had a stroke may not show any signs until months or years later. They may develop more slowly than other children, and may tend to favour one hand over the other. Other signs include:

• Seizures in one area of the body, such as an arm or a leg
• Trouble breathing or pauses in breathing (apnea)
• Developmental delays, such as rolling over and crawling later than usual

Common symptoms of stroke in children and teens

• Weakness, numbness or paralysis on one side of the body
• Difficulty speaking or understanding others
• Blurred or double vision
• Dizziness or loss of balance or coordination
• Tightness or restricted movement in the arms and legs
• Memory loss and difficulty concentrating
• Sudden mood or behavioural changes
• Headaches, possibly with vomiting

Less common symptoms of stroke in children and teens

• Severe headaches, possibly with vomiting
• Tightness or restricted movement in the arms and legs
• Memory loss and difficulty concentrating
• Sudden mood or behavioural changes

Warning signs of a stroke

The FAST test can be used to help identify strokes in children:

• Face: Can the child smile? Has their face fallen on one side?
• Arm: Can they raise both arms?
• Speech: Can they speak clearly and understand what you say? Is their speech slurred?
• Time: If you see any one of these three signs, it’s time to call 911.

What to do if you suspect a child is having a stroke

If your child is having a stroke, it's important to act quickly. Lay your child flat and do not give them food or drink. Call 911 or your local emergency number immediately.

How strokes are diagnosed in small children

Diagnosing a stroke in small children can be challenging as symptoms are not always recognizable. A stroke is a life-threatening condition that occurs when blood flow to the brain is interrupted. Pediatric strokes can happen in infants, children, teens, and even before birth.

To diagnose a pediatric stroke, a healthcare provider will first talk to the parents about the child's symptoms and perform a physical examination. They may then order specific tests, depending on the child's symptoms. These tests can include:

• CT scan (computed tomography scan) of the head to check for brain bleeds or areas affected by blood clots.
• CT angiogram to visualize blood flow through the heart, blood vessels, and brain.
• Brain MRI (magnetic resonance imaging) to help visualize the structure of the brain and blood vessels. This is the most sensitive test for diagnosing a stroke.
• Magnetic resonance angiogram (MRA) to show blood flow.
• Echocardiogram (Echo) to examine the heart structure.
• Electroencephalogram (EEG) to determine if the child is experiencing seizures.
• Blood tests to check for sickle cell disease or conditions that cause blood clots.
• Genetic testing if certain genetic disorders are suspected as the cause of the stroke.

It is crucial to seek immediate medical attention if a child exhibits any stroke-like symptoms, as prompt treatment can significantly impact their health and recovery.

How strokes are treated in small children

Strokes are rare in children and adolescents, but they do sometimes occur. Pediatric stroke is a life-threatening condition that requires immediate medical attention. If you suspect your child is having a stroke, call 911 or your local emergency number right away. The treatment for a pediatric stroke depends on the type of stroke and is time-sensitive.

Ischemic Strokes

For ischemic strokes, which are caused by blood clots, providers often use medications like thrombolytics to restore blood flow to the child's brain. In some cases, a procedure called thrombectomy may be performed.

Hemorrhagic Strokes

Hemorrhagic strokes are caused by bleeding in the brain. For these strokes, surgery may be necessary to control the bleeding.

Medical Therapy

Your child may receive aspirin or other blood thinners (anticoagulants) and special vitamins as part of their medical therapy. If the child has sickle cell disease, they may be treated with hydroxyurea or transfusion therapy. If the stroke is causing seizures, anti-seizure medication will be administered.

Interventional Neuroradiology

If your child has abnormal connections in blood vessels that feed the brain (arteriovenous malformation) or weakened blood vessel walls that can burst (aneurysm), doctors may place a catheter inside the affected blood vessel to repair the abnormal area. This procedure can also be used to remove large clots in blood vessels and restore blood flow to the brain.

Surgery

In some cases, surgery may be necessary to treat certain types of stroke and other cerebrovascular disorders. The type of surgery will depend on the cause of the stroke. For example, in cases with severe brain swelling, a craniectomy may be performed to remove a piece of bone. Other surgeries include closing abnormal blood vessels, removing abnormal areas of the brain, and rerouting blood vessels to provide blood supply to injured areas.

Rehabilitation

After the initial treatment, your child will likely need pediatric stroke rehabilitation. They may receive care from a team of specialists, including a pediatric neurologist, cardiologist, hematologist, neurosurgeon, speech-language pathologist, and occupational therapist.

Long-term problems caused by strokes in small children

While strokes are rare in small children, they can still occur and cause long-term problems. Here are some potential long-term issues that can arise:

Neurological Disabilities

Strokes can lead to neurological disabilities, causing permanent long-term cognitive and motor impairments in children. These impairments can affect various aspects of the child's life, including their ability to walk, see, speak, or read. In some cases, the stroke may cause a seizure disorder or impact the child's thinking, emotions, personality, behaviour, or memory.

Weakness or Numbness

Children who have had a stroke may experience long-term weakness or numbness on one side of their body. This can affect their ability to perform daily tasks and participate in physical activities.

Vision Problems

Vision issues are also a potential long-term effect of strokes in small children. They may experience double vision, loss of vision, or other visual impairments that can interfere with their daily lives and development.

Seizure Disorders

Strokes can increase the risk of developing epilepsy or other seizure disorders in children. These disorders can have a significant impact on the child's quality of life and may require ongoing medical management.

Cognitive and Learning Difficulties

Strokes can cause cognitive problems, including difficulties with thinking, learning, and memory. These issues can impact the child's educational attainment and their ability to acquire new skills.

Behavioural and Emotional Changes

The impact of a stroke on a child's brain can lead to behavioural and emotional changes. They may experience changes in personality, mood swings, or difficulties regulating their emotions.

Recurrent Strokes

Children who have had a stroke are at an increased risk of having another one. Recurrent strokes can lead to further brain damage and more severe long-term complications.

It is important to note that early diagnosis, prompt treatment, and rehabilitation can help minimize the risk of these long-term problems and maximize the child's recovery. Each child's experience is unique, and the specific long-term effects will depend on the area of the brain affected by the stroke and the extent of the damage.

Frequently asked questions