Although they're less common in kids, strokes occur in children of all ages, even those who haven't been born yet.
What is a stroke?
A stroke is a biological event (sometimes called a "brain attack") that happens when blood flow to the brain stops, even for a brief second.
When an ischemic stroke occurs, these important substances can't get to the brain and brain cells die. This can permanently damage the brain and cause a person's body to no longer function normally.
Strokes also can happen when a blood vessel in the brain breaks, flooding the brain with blood and damaging brain cells. This is known as hemorrhagic stroke.
Strokes in children most often happen between the 28th week of pregnancy, before a child is born, and 1 month after birth. Because they occur during the time surrounding birth, they're sometimes called perinatal strokes. Perinatal strokes usually occur during delivery or right after delivery because the baby doesn't get enough oxygen while traveling through the birth canal.
What causes it?
Determining the cause of a stroke in a child can be difficult. If your child has had a stroke, the doctor might not have definite answers for you, but can tell that a stroke occurred by using medical tests. About one third of all childhood strokes aren't related to any disease, condition, or injury that's known to increase the risk of stroke.
While strokes in adults happen more often because of high blood pressure, diabetes, or atherosclerosis, the risk factors for stroke in children are more varied.
Ischemic strokes, the most common type in children, are usually related to:
- Lack of oxygen during birth
- A heart defect present at birth
- Blood disorders such as sickle cell anemia, a disease that destroys blood cells and blocks blood vessels
- Injury to an artery (a blood vessel that brings oxygen) in the brain
- Genetic disorders like Moyamoya, a rare disease that affects arteries in the brain
- An infection, such as meningitis or chickenpox
Certain problems that affect a mother during pregnancy can also cause a baby to have an ischemic stroke before or after birth. Examples include:
- Preeclampsia (high blood pressure during pregnancy that can cause swelling in the hands, feet, and legs)
- Premature rupture of the membranes (when a woman's water breaks more than 24 hours before labor starts)
- Drug abuse
- Placenta problems that decrease the baby's oxygen supply, such as placental abruption
Hemorrhagic strokes can be caused by:
- A head injury that results in a broken blood vessel
- Arteriovenous malformation, a condition in which the blood vessels in the brain don't connect properly
- An aneurysm (weakness in an artery wall)
- Diseases that affect blood clotting, such as hemophilia
Signs of a stroke in infants
- Seizures in one area of the body, such as an arm or a leg
- Problems eating
- Trouble breathing or pauses in breathing (apnea)
- Early preference for use of one hand over the other
- Developmental delays, such as rolling over and crawling later than usual
How is a stroke diagnosed?
Perinatal and early childhood strokes can sometimes be hard to diagnose, especially if a child has no obvious signs or symptoms. In some cases, a stroke is found to be the cause of seizures or developmental delays only after many other conditions have been ruled out. This might mean that a child will undergo several tests before the doctor even mentions the word "stroke."
If stroke is suspected, a doctor will probably want the child to undergo one or more of these medical tests:
- Blood tests
- Magnetic resonance imaging (MRI): a safe and painless test that uses magnets, radio waves, and computer technology to produce very good pictures of internal body parts, such as the brain
- Magnetic resonance angiography (MRA): an MRI of specific arteries
- Magnetic resonance venography (MRV): an MRI of specific veins
- Computed tomography scan (CT or CAT scan): a quick and painless test that produces pictures of bones and other body parts using X-rays and a computer
- Computed tomography angiography (CTA): an X-ray of specific arteries
- Cranial ultrasound: high-frequency sound waves that bounce off organs and create a picture of the brain
- Lumbar puncture (also called a spinal tap)
How is it treated?
Treatment will vary based your baby's diagnosis.
What are the possible complications?
The brain damage that occurs during a stroke can cause a number of other problems that could affect your child throughout life, including:
- Cerebral palsy
- Intellectual disability
- Paralysis or weakness on one side
- Communication problems
- Vision deficits
- Psychological difficulties
Babies who've had a stroke will see doctors who specialize in helping them cope with these problems both in childhood and adulthood. These specialists might include occupational, physical, and speech therapists. In addition, your child's care might be overseen by a neurorehabilitation specialist who uses many different types of therapy to help your child recover from stroke.
What is the outlook for my baby?
At this time, no treatment exists that will fix brain cells that have died. However, one amazing thing about the brain is that undamaged brain cells can learn to perform the jobs of cells that have died, especially in young people.
In many cases after a stroke, kids can be taught to use their arms and legs and speech through brain retraining. Although this process is usually slow and difficult, children have an edge over adults because their young brains are still developing. Most kids who have had strokes are able to function normally in society and grow to be productive members of their communities.
Don't be afraid to ask questions about your child's condition or treatment or to ask for help when you need it. You aren't facing your child's care alone. In addition to the doctors and therapists who will be working with your child, Cook Children's offers support groups for parents of kids who have had strokes and for those who have a risk of additional strokes or permanent disabilities. It can be helpful to seek support from other parents facing the same challenges.
We're here to help.
If you are interested in scheduling a tour of our NICU, please call 682-885-4375. You can find information on how to refer a patient or other NICU contact information here.