Stroke is one of the top ten causes of childhood death and estimated to affect 400 children in the UK every year. Despite this, it is a condition mainly associated with adults and the elderly. There is a massive lack of both public and professional understanding when it comes to acknowledging and recognising that stroke can hit anyone, even babies and children. Because of this, it is important for parents and carers to be aware of the signs and symptoms of stroke and act fast if you think your child has had one.
What is stroke?
Stroke is known as a ‘brain attack’ and happens when there is an interruption of the blood supply to the brain.
The parts of the brain not being supplied by blood can become damaged. This can then lead to a lack of control of certain functions during the stroke and in its aftermath such as speech or mobility.
Strokes are caused by different problems and leave different, sometimes lasting effects depending on how much damage has been caused and which part of the brain has been affected.
The main cause of stroke in approximately 50 per cent of children is a bleed in the brain due to burst blood vessels, brain infection, head injury and extreme dehydration.
A blockage in blood vessels known as an ischaemic stroke results from heart disease, heart surgery, brain tumour and even chickenpox.
Other known risk factors for childhood stroke include sickle cell disease, thalassaemia, Moyamoya disease and Takayasu’s disease.
“The causes of childhood stroke are different to adults,” says Elspeth McAusland, spokesperson for the Stroke Association. “There are many possible causes for stroke in children. With adults, strokes are often brought on by smoking, high blood pressure or the ‘furring up’ of the arteries. In contrast, many childhood strokes are as a result of other underlying issues – like sickle cell disease or heart problems.”
“It is common to find narrowing of blood vessels which carry blood to the brain in childhood stroke patients. The cause of this narrowing, despite tests, is often not found. Rarely it may be associated with previous chickenpox infection. However, in around 10% of children who have a stroke, no cause is identified despite extensive tests.”
What are the symptoms?
Though caused by different factors to adults, the signs that a child has had a stroke are similar in all age groups. The Stroke Association recommend that parents act FAST -
Face: Can the person smile? Has their mouth or eye drooped?
Arm: Can the person raise both arms?
Speech: Can the person speak clearly and understand what you say?
Time: To call 999
In younger children, particularly toddlers, it may be difficult to recognise these signs due to the early stage of development the children are at.
Most commonly there will be a weakness on one side of the child’s body
They may not be able to raise one of their arms
Their face may droop on one side and their speech may be affected
Sometimes strokes will affect the area of the brain responsible for balance and coordination
Children may complain of a severe headache
Some children may have a fit at the time of the stroke
What should you do if you suspect your child is having or has had a stroke?
A stroke needs to be treated as a medical emergency, so be aware of the symptoms and dial 999 immediately. Because awareness of childhood stroke is so low, diagnosis can be slow so stick to your instincts when dealing with medical professionals.
During a stroke the brain is being attacked so the more time that is lost, the more damage potentially being caused.
The Study of Outcome of Childhood Stroke
The lack of awareness that children can suffer strokes has until now been matched by a lack of awareness into their long term rehabilitation and how well they recover.
The Stroke Association is currently addressing this issue and has funded a research project Study of Outcome of Childhood Stroke being carried out at the University of Bristol and led by Doctor Andrew Mallick.
The study, due to finish shortly, has been assessing how well children recover from stroke.
Until now, much research into childhood stroke has come from top specialist hospitals such as Great Ormond Street which have only seen the most severest of cases instead of a balance of both ends of the scale.
Researchers in Bristol are now aiming to provide a more realistic picture of the effects of childhood stroke by analysing all cases in a large geographical area.
Doctor Andrew Mallick explains: “We are studying the outcome on a population basis – i.e. all children in a large, defined geographical area, regardless of whether they went to a specialised hospital or not. We hypothesise that data from specialised hospitals are likely to include a higher proportion of more severe cases than data collected on a population basis.”
The parents of children who have had a stroke helped the researchers design a study assessing post-stroke aspects of life that were of great concern to the families involved, such as quality of life, behavioural changes and motor skills.
The researchers then looked at children in the South of England aged between 28 days and 16 years, who had a stroke between July 2008 and June 2009.
Around 180 children in a region of six million had a stroke during this time. The data collection for the study is due to finish this month and the analysis to begin.
Is there a link between childhood stroke and chicken pox?
Brain infections such as meningitis and encephalitis are well known to lead to stroke. Less commonly yet still a risk is the seemingly innocuous childhood illness chickenpox.
“There does appear to be an association between chickenpox and stroke but it is not clear why some children are fine after chickenpox and others seem to get strokes,” says Dr Mallick.
“Other specific organisms linked to stroke are enteroviruses, parvovirus B19, Mycoplasma pneumoniae and Borrelia burgdorferi (Lyme disease).
“Very recent research shows that children with strokes caused by narrowed blood vessels in the brain were more likely to have had a recent upper respiratory tract infection (e.g. a common cold / runny nose) than children who had a stroke but without narrowed blood vessels. This suggests that even simple / common infections may lead to narrowing of blood vessels in some children. Further research is now under way to look at why this occurs in some children but not others.”
Why is childhood stroke not well known?
The Stroke Association are aiming to raise more awareness about childhood stroke for both parents and professionals.
The charity is calling for an audit of stroke care for children in the UK, more research into the causes and outcomes of stroke and an increased effort at raising awareness for both the public and medical profession.
Where can you go for support?
It can be really useful for families of children affected by childhood stroke to get support from other parents who have been through the same thing.
South West mother Soniya Munday knows only too well the impact of childhood stroke on families. In June 2008, her son spent two months in Bristol’s Frenchay Hospital having undergone eight hours of open brain surgery to repair damage caused by a brain haemorrhage and stroke.
Echoing the concerns of the Stroke Association, Soniya says from her own personal experience: “Most children and babies do not survive due to the stroke not being diagnosed quickly enough. The signs are the same as in adults, but because medical professionals are not educated properly to recognise the signs, when it is detected the child dies or is left heavily brain damaged for life.”
Soniya has now set up and runs ChildStrokeSupport.com to provide an online community raising awareness, offering advice, support and chat for families affected by childhood stroke or Arterio-Venous Malformation (AVM) - a tangle of abnormal arteries and veins in the brain formed before birth.
For more information and to join the community, visit: http://www.childstrokesupport.com/
Contact a Family: www.cafamily.org.uk
Children’s Brain Injury Trust: www.cbituk.org
The Brainwave Centre: www.brainwave.org.uk
The Stroke Association: www.stroke.org.uk
Study of Outcome of Childhood Stroke: www.childstroke.org.uk