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About Physiatry

Pediatric Stroke

Condition: When blood flow to part of the brain is blocked or reduced, the brain tissue is affected and brain cells begin to die. This is known as a stroke. When an infant or child under the age of 18 has a stroke, it is known as a pediatric stroke.

Background: Approximately 3 children out of 100,000 are diagnosed with a stroke each year. However, pediatric strokes are often misdiagnosed, so the actual rate may be higher. More than half of pediatric strokes are ischemic, which means they are due to an obstruction in a blood vessel that carries blood to the brain, such as a blood clot.

Risk Factors: Boys and African American children are at higher risk for stroke. Certain disorders that lead to increased blood clotting, such as congenital heart defects, sickle cell disorder, trauma, or cancer also put children at a higher risk.

History and Symptoms: With infants, often the only symptoms are seizures or an altered mental state. Examples of other symptoms include nausea, vomiting, and headaches.  

Physical Exam: All adults should know about FAST. If an adult believes a child is having a stroke, he/she should do the following:

  1. Face: Ask the child to smile. If one side of the face droops, it could indicate stroke.
  2. Arms: Ask the child to lift both arms. Does one go downward?
  3. Speech: Ask the child to repeat a simple phrase. Is it slurred or strange?
  4. Time: If any of these symptoms are present, call 911 immediately.

Diagnostic Process: To better understand the type of stroke and areas of the brain affected, a rehab physician/PM&R physician may order imaging tests such as a CT scan, or an MRI.

Rehab Management: Rehabilitation varies. For example, as a result of a stroke, some children may develop other conditions, such as seizures or paralysis on one side. Other children may have difficulty with talking and eating while others may have problems with thinking or learning. The goal of rehabilitation is to maintain and restore function after the stroke. This can include physical therapy to improve gross motor skills, strength, and balance, occupational therapy to improve fine motor skills and activities of daily living (eating, bathing, toileting, brushing hair, etc.) and speech therapy to help with speech and swallowing. Bracing and splints may give joints stability and help preserve range of motion. Medicines can be used to help with excessive muscle tone. It is also important to work closely with the patient’s school so that they may understand the patient’s needs and receive the appropriate services for their particular deficits. 

Other Resources for Patients and Families: The Children's Hemiplegia and Stroke Association helps families with children who have had strokes. 

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