Pediatric Stroke: What You Need to Know

Of the many worries parents have for their kids, suffering a stroke is rarely at the top of the list.

However, pediatric strokes, while rare, do occur, affecting one in every 1,100 newborns and an additional 2,000 older children each year. A stroke is caused by either a blood clot or bleeding in the brain, which, if left untreated, can lead to damage or death of brain tissue.

Whether a person suffering a stroke is an adult or a child, getting quick treatment from stroke specialists and the availability of recovery and re-integration resources can lead to better results.

St. Louis Children’s Hospital—along with its partners at Barnes-Jewish Hospital and Washington University Physicians—provides a fully integrated and comprehensive program for children experiencing strokes that saves lives and improves recovery.

Knowing what to look for and what to do if your child shows stroke symptoms is crucial to getting them life-saving care, says Kristin Guilliams, MD, a Washington University pediatric neurologist at St. Louis Children’s Hospital.

“The good news is the signs and symptoms of stroke in children are similar to adults,” Dr. Guilliams said. “So the FAST/BEFAST acronym applies.”

BE FAST stands for the common symptoms of experiencing a stroke, and what should be done: 

• Balance loss

• Eyesight changes

• Face drooping

• Arm weakness

• Speech difficulty

• Time to call 911

If a child experiences a sudden seizure or headache, parents should call 911 or get them to an emergency room immediately, as time is of the essence in stroke care.

When the team suspects a stroke, experts are called to the patient’s bedside within 30 minutes for rapid imaging, diagnosis and initial treatment.

“Just having people who are stroke specialists caring for you increases your chance of a better outcome,” Dr. Guilliams said.

If a stroke is confirmed, patients receive clot-busting medication right away. If additional treatment is needed to remove a clot, the medical team can walk the child next door to Barnes-Jewish Hospital.

“Our kids get the best of both worlds with Barnes-Jewish Hospital’s stroke specialists helping with procedures, and then back to recovery at our pediatric intensive care unit,” Dr. Guilliams said. “Our ability to stay with our patients and walk back and forth with them between facilities, and not lose any of their pediatric specialist care, is an important part of their treatment.”

BJC has hospitals throughout St. Louis and the surrounding region, which allows for speedy diagnosis and transfer to St. Louis Children's Hospital for life-saving treatments. St. Louis Children’s also works with hospitals outside of BJC to share guidelines, education and transfer protocols to help a child experiencing stroke symptoms get the extraordinary care they deserve as quickly and safely as possible.

The St. Louis Children’s Hospital neuro rehab program provides additional support to help the child transition back into the home, school, and the community. St. Louis Children’s Hospital has the only pediatric inpatient rehabilitation program certified by the Commission on Accreditation of Rehabilitation Facilities in the St. Louis area.

Child life specialists help patients who need to remain in the hospital for rehab with ways to cope with fear, anxiety, and separation from friends and family by using play, music, art, recreation and education techniques.

Dr. Guilliams said the stroke and neurocritical care team follows patients after they leave the hospital.

“Even if they don’t meet the criteria for intensive inpatient rehab, we still have a neurocritical care follow-up for kids with strokes, to continue that support and integration back into school,” she said. “This starts with their hospital discharge; we learn more about their needs once they get back home, and that transition and recovery is just as important as what we do in the hospital. This is the only place in the St. Louis region with complete comprehensive care.”

Parents should be aware of the symptoms of stroke, and not wait to call 911 if their children are experiencing any of the BEFAST symptoms. Dr. Guilliams noted that even those who do not have a confirmed stroke may have another neurologic condition that needs attention.

According to Dr. Guillians, the St. Louis Children’s Hospital team conducted more than 100 stroke evaluations last year, with 18 final stroke diagnoses. “The other times were often seizure-related or headache-related. They were almost always neurological issues.”

A pediatric stroke can sound frightening. However, it is extremely rare for a child to die from a stroke, and many children will spontaneously regain lost function after stroke treatment. Dr. Guilliams remembered a teenager with severe weakness and balance issues, who made a quick recovery after treatment.

“I saw them come back to themselves within only a few days,” she said. “They didn’t even need rehab. You are a teenager, and you have no idea how your life trajectory may have changed if we hadn’t been able to treat your stroke. But that’s ok, because I do.”

Learn more about St. Louis Children’s Hospital’s Stroke and Cerebrovascular Program.