Recognizing the signs and symptoms of stroke in children

When we think of strokes, we imagine older adults. Yet, one out of every 2,800 newborns (under 1-month) suffers a stroke. In children up to 18, it occurs in 11 out of 100,000. I know how serious this can be – my daughter experienced a stroke before birth. The day before she was born, we discovered she had hydrocephalus (water on the brain). When she was a day old, an MRI revealed that a stroke was the culprit. Why strokes occur prior to birth is a mystery.

My daughter is now a happy, healthy 2-year-old. However, as a pediatrician and mother, I believe it is important to build awareness about childhood strokes. We may not know a lot about why these strokes happen or how to prevent them, but early diagnosis is key. The earlier the diagnosis, the sooner a child can begin therapy to regain function. Recognizing the symptoms of a stroke can be tricky, especially in a younger the child.

Strokes occur when blood flow is interrupted in the brain, resulting in tissue injury or loss of brain function. In infants, this may result in seizures on one side of the body, apnea (prolonged pause in breathing for more than 20 seconds), trouble feeding, or early hand preference (i.e., using one hand far more than another before 10 months of age). Strokes often damage one side of the brain, which causes an abnormal signal to be sent to one arm and one leg and results in abnormal muscle weakness, tightness or accentuated use of one hand. This condition is known as Hemiplegia.

As with my daughter, strokes can occur in the womb and are likely the result of many factors. For premature births the possibility of stroke goes up, though preemies are regularly screened from day one.

Recognizing the signs and symptoms

In young children, delays in gross motor skills, restricted movement in legs or arms or language delays might be red flags. In older children, stroke-like symptoms may include garbled speech, seizures, and one-sided paralysis. Most hospitals have a protocol in place to detect stroke.

In my patients I also look for more subtle signs, which alone are not worrisome but if clustered raise a red flag. Some of these signs include torticollis (tight neck muscles on one side), visual/ eye abnormalities, a general delay in motor skills, tight muscles in the extremities, difficultly eating or speaking.

More than 100 risk factors have been identified for infant and childhood strokes, but for many families the “why” remains an unknown. Some genetic conditions that can predispose a child to stroke include clotting disorders, sickle cell disease (more prominent among African Americans), heart issues, metabolic and vascular disorders, and infections (including chickenpox). It remains an area of ongoing research.

Parents do not be shy; alert your pediatrician if you notice any delays or early hand preferences. If there is a combination of some of the signs already mentioned, share your concerns with your pediatrician immediately and be informed about your family history. When diagnosing an early childhood stroke the more puzzle pieces available, the more likely your doctor can provide you with answers.

Veronica Szalkowski-Lehane is a pediatrician at the University of Utah Stansbury Health Center.

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