Can Kids Have Strokes??
- foamfrat
- 11 minutes ago
- 4 min read
When you think about strokes, you probably picture a slurred speech, middle-
aged hypertensive smoker with half their face drooping. You don’t picture a
toddler in a car seat or a baby in a crib. But the reality is that strokes happen to kids, too.
As paramedics, we thrive on pattern recognition, but pediatric strokes are the
ultimate zebra in the room. They don’t present like adult strokes; they’re incredibly rare,
and the clock is still ticking as fast. The question isn’t whether you’ll encounter one;
it’s whether you’ll recognize it when you do.
Pediatric strokes are rare but do happen. The estimated incidence is 2.5-13 per 100,000 pediatrics a year(Hollist et al). Because strokes, especially in pediatrics, have varying signs and symptoms, delays in recognition and treatment are common.
Why Do Kids Have Strokes?
Kids don’t have the same risk factors as adults. They’re not downing cheeseburgers
and skipping their blood pressure meds. Instead, pediatric strokes are tied to:
Congenital heart defects: Those murmurs or repaired holes? They can lead to clots.
Sickle cell disease: Think beyond pain crises; sickle cell disease greatly increases stroke risk. 7.4% of children with Sickle Cell Disease will have a symptomatic
stroke by age 14 (Linguet et al., 2024).
Head or neck trauma: Even something as simple as a tumble off the monkey bars can
disrupt blood flow.
Infections: Meningitis, chickenpox, and other illnesses can lead to inflammation or
clotting problems.
Unknown causes: Sometimes, even with every test under the sun, we never figure out
why.
And for neonates, strokes can occur during or right after birth. Those kiddos might not
show symptoms for months or years, making early recognition even more challenging.
What Does a Pediatric Stroke Look Like?
If only pediatric strokes came with a flashing neon sign. Instead, the symptoms can be
subtle, vague, and easily dismissed. Here’s what you might see:
Seizures: A stroke might be the reason for a seizure, especially if there’s no history of
epilepsy. One study shows that 21% of pediatrics had a seizure in the presence of an acute
stroke, with another 10% having a seizure during their hospitalization(Singh et al, 2012)
Sudden weakness or paralysis, usually on one side. A kid who stops using their right
arm out of nowhere? That’s not just “weird.”
Speech issues: Slurred speech or difficulty finding words is a big red flag in older kids.
For babies? Look for unusual crying or changes in vocalization.
Loss of coordination: Unsteady walking, trouble sitting up, or sudden clumsiness could
mean more than just tiredness.
Headaches and vomiting: While less common, especially in younger kids, they
shouldn’t be ignored.
For infants, it’s even murkier. You might notice developmental delays, a preference for
using one side of their body, or poor feeding. It’s like playing detective without any
leads.
The FAST Acronym Works—For Kids, Too
Let’s dust off the FAST acronym:
- Face: Is one side drooping?
- Arms: Can they move both arms equally?
- Speech: Is it slurred or unusual?
- Time: If you suspect a stroke, time is critical.
We teach this for adults, but how often do we think about it for kids? Pediatric strokes
are just as time-sensitive as adult strokes. The longer the brain goes without oxygen,
the worse the damage.
Your Role in the Prehospital Setting
Let’s be honest: pediatric patients can be intimidating. They’re tiny unpredictable, and
sometimes the only history you get is the panicked words of a parent who knows something is wrong. Regarding pediatric strokes, your job is to think big, act
fast, and advocate hard.
- Don’t dismiss symptoms: A 10-year-old who suddenly can’t move their left arm isn’t
faking it. Listen to your gut.
- Ask the right questions: Recent illnesses? History of sickle cell or heart conditions?
Any trauma? The more you know, the better prepared the receiving facility will be.
- Transport to the right place: Not all hospitals are created equal. A pediatric stroke
needs a pediatric stroke team, period. Advocate for a destination that can provide the
right care, even if it’s farther away.
The Toughest Part: Trusting Yourself
Here’s the truth: you might not catch every pediatric stroke. They’re rare and
sneaky, and we’re not trained to expect them. But when you get that feeling—that little
voice whispering something’s not right—listen to it.
You’re the first link in the chain. You might be the only one who notices the signs before
it’s too late. You’re not just a paramedic; you’re the kid’s advocate, their lifeline, their
chance at walking away from this.
The Takeaway
Pediatric strokes are rare, terrifying, and absolutely possible. They don’t fit the mold
we’re used to, but they demand the same urgency and attention as adult strokes. The
next time you’re kneeling in front of a kid who doesn’t quite seem right, ask yourself:
Could this be a stroke?
Because maybe, just maybe, that question saves their life.
References:
Hollist, M., Au, K., Morgan, L., Shetty, P. A., Rane, R., Hollist, A., Amaniampong, A., &
Kirmani, B. F. (2021). Pediatric Stroke: Overview and Recent Updates. Aging and
disease, 12(4), 1043–1055. https://doi.org/10.14336/AD.2021.0219
Linguet SL, Verlhac S, Missud F, Holvoet-Vermaut L, Brousse V, Ithier G, Ntorkou A,
Lesprit E, Benkerrou M, Kossorotoff M, Koehl B. Stroke without cerebral arteriopathy in
sickle cell disease children: causes and treatment. Haematologica. 2024 Oct
1;109(10):3346-3356. doi: 10.3324/haematol.2023.283773. PMID: 38497171; PMCID:
PMC11443367.
Singh, R. K., Zecavati, N., Singh, J., Kaulas, H., Nelson, K. B., Dean, N. P., Gaillard, W.
D., & Carpenter, J. (2012). Seizures in acute childhood stroke. The Journal of
Pediatrics, 160(2), 291–296. https://doi.org/10.1016/j.jpeds.2011.07.048
