While strokes most commonly affects individuals over the age of 65 they can occur in children as well. Approximately six children out of 100,000 will be affected and between 10 and 20 percent of those cases will be fatal. Stroke occurs even less frequently in a fetus, but involves many preventable or manageable risk factors. The prevalence in children seems to be increasing for reasons that remain unknown.
Children with certain health conditions are most prone to experience a stroke. Genetic disorders like sickle cell anemia, tuberous sclerosis, and Marfan’s syndrome increase the risk to the pediatric population as well as a history of brain infection, brain injury, heart defects, and vascular malformations. Severe dehydration, meningitis and chickenpox make a child more susceptible as well.
In children who are unable to speak yet a deficit may be hard to recognize. Additionally, the symptoms in children are sometimes different than those identified in adults.
A child who is having a stroke may experience seizures (with or without vomiting) which often affect just one side or area of the body. Children may display signs such as speech impairment, a rapid loss of speech, difficulty eating, vision problems, loss of body language or gestures, weakness on one side of the body (hemiparesis), unilateral paralysis (hemiplegia), headache, fever, or convulsions, memory loss and sudden mood or behavioral changes. Any of these symptoms require immediate medical intervention. While the condition may prove fatal, children are more likely than adults to recover fully with prompt treatment and rehabilitative efforts. A child who does not have seizures along with the cerebrovascular accident (CVA) is more likely to make a full recovery.
Stroke is more likely to occur in a fetus or infant in the first month of life if the mother suffers from preeclampsia, diabetes, infections, threats to the baby’s oxygen supply, drug abuse or her membranes rupture more than 24 hours prior to labor. In this extremely young population it typically occurs between the 28th week of pregnancy and soon after birth, but sometimes up to one month of age. Unfortunately, in the event of a perinatal CVA, symptoms may not become apparent until several months or sometimes even years later.
Any child who suffers from a CVA is more likely to suffer from another one, a seizure disorder, and developmental deficits than those who do not, but given the high plasticity of a young child’s brain a normal life remains within reach for many of these children. It has also been found that as the period of time following the occurrence increases without recurrence the likelihood of having another decreases significantly.
It is important for parents to know the signs in children and that they advocate for their child in the healthcare setting as professionals do not often suspect stroke in this, the most vulnerable, population. Parents know their children best and need to quickly seek a second opinion in the event a satisfactory explanation is not found.
An assistant professor of pediatric neurology at Johns Hopkins Children’s Center said “strokes in kids are rare” stating “they are as common as brain tumors” and it is the brain tumors that get more attention. The neurologist stated if more focus is placed on understanding strokes, the greater awareness individuals and parents will have.
There are several risk factors that can be avoided or managed during pregnancy such as preeclampsia, diabetes and drug abuse. Any woman at risk for having a child born with a heart defect or certain genetic disorder should consult a doctor who is aware of the risk posed to the fetus.
In children with known susceptibilities, parents need to be vigilant in their observation of their child’s behavior. Children with sickle cell anemia can have their risk reduced by getting blood transfusions.
Despite the low incidence of stroke in children, the most vulnerable population, treatment and recovery are within reach. Clinicians and caregivers need to be aware of the symptoms and with further research positive outcomes will become more common.
By Lara Stielow