Stroke: not just an adult’s condition
Repetitive twitching of the face, arm or leg can be an indicator of stroke in newborns, as can a pause in breathing alongside prolonged staring and extreme fatigue.
As children develop, the signs of symptoms of stroke are very similar to those in adults. Weakness or numbness on one side of the body and problems speaking or understanding language - such as slurred speech or problems understanding simple instructions - may be signs of stroke.
Other signs of stroke among children may include severe headache, vomiting, fatigue, severe dizziness and appearance of seizures.
The American Stroke Association stress that the F.A.S.T. acronym is an easy way to remember the sudden signs of stroke in both children and adults:
- Face drooping. Is one side of the face numb or drooping? Is the individual able to smile?
- Arm weakness. Is one arm numb or weak? Ask the individual to lift both arms. Does one arm drift downward?
- Speech difficulty. Is the individual’s speech slurred? Do they find it hard to speak or are they hard to understand? Can they correctly repeat a simple sentence, such as “the sky is blue?”
- Time to call 911. If the individual shows any of these symptoms, call 911 immediately, even if the symptoms disappear. Check the time at which first symptoms appear.
“Think stroke, act fast and call 911. That message applies to adults and children,” says Dr. MacKay. “Getting to the hospital quickly is an essential first step to develop strategies to improve access to emergency treatment in children.”
Treatment options for pediatric stroke
For adults suffering ischemic stroke, the first port of call in terms of treatment is the medication tissue plasminogen activator (tPA), which works by dissolving any blood clots that are blocking the arteries, restoring blood flow to the brain. Such treatment must be administered within 3 hours of symptom onset - 4.5 hours for some patients.
The use of tPA among young children with ischemic stroke, however, is controversial. Since children and adults have physiological differences, health care professionals are concerned about the drug’s safety and efficacy among children - something that is currently being investigated.
As such, stroke treatment for children tends to vary depending on the cause of their stroke and any underlying medical conditions they may have. A child whose stroke was caused by a heart defect, for example, may be treated with blood-thinning medication, such as warfarin or aspirin.
Children who suffer stroke have around a 15-18% chance of suffering another stroke. Therefore, many children may receive treatment to prevent stroke recurrence, such as antithrombotic therapy - medication that stops blood clots from forming or growing.
One crucial treatment for the majority children who suffer stroke is rehabilitation therapy, which can involve physiotherapy, occupational therapy and speech therapy.
Sixty percent of children experience neurological problems, such as hemiplegia or hemiparesis cerebral palsy, following stroke. Rehabilitation therapy can really help reduce the neurological effects of stroke, and the earlier treatment is started, the more likely it is to succeed.
Severe delays in diagnosis of pediatric stroke
But as Dr. MacKay’s study showed, many parents either do not consider the possibility that their child is suffering a stroke or are unable to recognize the signs, which can severely delay treatment.
Dr. MacKay’s findings revealed that the average time from symptom onset of pediatric stroke to arrival at the emergency room was 1.8 hours, with some arrivals taking up to 4 hours.
And it is not only parents who may overlook the signs and symptoms of pediatric stroke - doctors can too. Studies have found that in the US, it can often take longer than 24 hours to diagnose stroke in children.
A report from ABC News in 2011 provides evidence of this, revealing how it took more than 25 hours for doctors to diagnose a 15-year-old boy from Ohio with stroke.
Because of the delay in diagnosis, the boy had to have a part of his skull removed to ease pressure from the build up of blood in his brain.
In a 2008 interview, Dr. Fullerton said she believes a delay in diagnosis of pediatric stroke has fallen into a gap in clinical care. “It is a rare disorder in general, and so most child neurologists will not be very comfortable in caring for children with stroke,” she said, adding:
“Stroke is considered more a disease of adults, but then adult stroke neurologists aren’t familiar of the etiologies of stroke in children or how to manage stroke in children, and so they’re often uncomfortable with caring for a stroke in a child.
It can be difficult to diagnose the etiology of their strokes. It often takes sophisticated imaging studies and studies that are done by very experienced practitioners. It really often does take a team approach to figure out why a child has had a stroke and figure out what is the best way to prevent more strokes in that child.”
While stroke is much rarer in children than adults, it is important that parents, caregivers and health care professionals are aware that children can be affected by the condition and take note of the signs and symptoms that may arise.
Not only is May American Stroke Awareness Month, 2nd-8th May is dedicated to World Pediatric Stroke Awareness Week. Set up by the IAPS and not-for-profit organization Brendon’s Smile last year, the campaign aims to raise awareness of pediatric stroke around the globe and educate communities about how the condition can impact children’s lives.
Visit the IAPS website to find out more about pediatric stroke and how you can help raise awareness of the condition.
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Written by Honor Whiteman