But the sad reality is that strokes can happen to anyone at any age, including children and even babies in the womb.

Stroke is the sixth leading cause of death in children, affecting approximately 6 to 10 in 100,000 children.

Strokes are so frequent among young people, Cook Children’s Medical Center houses a Comprehensive Stroke and Thrombosis Program, one of 16 such centers in the U.S. The program is led by co-medical directors: Marcela Torres, M.D., a hematologist/oncologist, and Fernando Acosta Jr., a neurologist.

““A problem with pediatric strokes, in contrast to those in adults, is that in pediatric strokes, the causes and circumstances are incredibly diverse, and they are also widely different within the pediatric age groups,” Dr. Torres said. “The potential causes of stroke vary radically from a neonatal stroke to the stroke that affects a teenager/young adult.”

Another challenge of pediatric stroke is risks, symptoms, prevention and treatment, all differ considerably between kids and adults. As a result, pediatric stroke is a niche study of medicine that isn’t as widely recognized, practiced or studied as other specialties.

While it can be extremely difficult to recognize symptoms of strokes in an adult, it’s even more so in children.

“It’s not uncommon for some types of strokes or after affects to go unnoticed,” Dr. Torres said. “Children’s strokes are often misdiagnosed as a migraine or viral illness. That’s dangerous because time is of the essence in treating a stroke.”

Strokes in adults are often brought on by lifestyle choices such as high cholesterol, a history of smoking, too much alcohol and obesity. For children, strokes are usually caused by heart birth defects, infections such as meningitis and encephalitis, brain blood vessel abnormalities trauma and blood disorders such as sickle cell disease, or unknown causes.

Stroke-related disabilities is another area where childhood and adult stroke survivors can differ. While strokes in children can be devastating, the good news is a child may be able to overcome the debilitation of stroke better because of the greater plasticity, or flexibility, of the child’s nervous system and brain. A child’s brain is still developing, therefore it may have a greater ability to repair itself. However, in contrast to an adult, a child has many more years to live with the disability associated with the stroke. With the help of physical and speech therapy, most childhood stroke survivors recover the use of their arms, legs and speech. Ongoing assessment of a child’s learning ability with recommendations for school are particularly important to a child’s success.

A comprehensive stroke program similar to that at Cook Children’s Medical Center, is focused on all aspects of stroke care including acute treatment and post stroke recovery. Cook Children's recently implemented an acute stroke alert system that involves nearly every aspect of the infrastructure of Cook Children’s to make this happen. This means that Cook Children’s is able to provide expert care in acute stroke with the goal of limiting the disability of the stroke and improve the quality of life for the rest of that child’s life. 

“Unfortunately pediatric strokes have been ignored for a long time as a true entity,” Dr. Acosta said. “This has changed over the last few years. The awareness is increasing.”

To Learn More:

• Stroke and Thrombosis Program at Cook Children's
• Strokes
• Newborn Stroke
• Stroke Clinic

Symptoms of a Stroke

The most effective stroke treatments must be given within the first three hours after stroke symptoms start. By recognizing signs of stroke in children and acting fast, you can help medical professionals lessen a stroke’s damage to the child’s brain.

Use the following tool to help you think BE F.A.S.T.:

Lori Lopez hoped to hear that her grandson, Mathew Westerman, was doing better and made some progress in his treatment for blood clots caused by a rare coagulation disorder. But she got more than she ever expected from the physicians overseeing her grandson’s care – Marcela Torres, M.D., a hematologist/oncologist and medical director of the Stroke and Thrombosis Program at Cook Children’s, and from Fernando Acosta Jr., M.D., a neurologist and associate medical director of the program.

“Dr. Acosta said, ‘They are gone. All the blood clots are gone,’” Lopez said. “I couldn’t believe it. I asked him to repeat it. I thought I didn’t hear him correctly. It was great. Dr. Torres told us he would no longer have to receive blood thinners, or injections, the infusions, the medication for seizures … it was a miracle. Honestly, it was a miracle to go in and hear this kind of news. I was like, ‘Oh my God. I didn’t know how to contain myself. I had so much joy and happiness with this news. It was the best news I had ever received.”

It was amazing how far Mathew, who was 1 when he became sick and is now 31 months old, had come. In October 2016, Mathew came down with a slew of health issues – two ear infections, strep throat, mono, pneumonia, asthma. He couldn’t seem to get well.

He was eating and drinking very little, causing dehydration and iron deficiency anemia. One morning, Lopez and Mathew’s mother, Catherine Arreola, noticed the little boy’s arms and feet twitching. He was having a seizure. They rushed him to the emergency room in San Angelo.

From there, Mathew was transported to Cook Children’s where he was diagnosed with thrombosis of the sinus veins of the brain. This is a type of stroke that occurs when a blood clot forms in the brain’s venous sinuses which prevent blood from being able to drain out of the brain. Brain damage can occur from the increased pressure and blood can leak out into the already damage tissue (known as a hemorrhagic stroke). This means that, unfortunately, Matthew had all three types of strokes: sinus vein thrombosis, ischemic and hemorrhagic.

Dr. Torres recognized Mathew’s symptoms as soon as she saw him and placed him on blood thinners. Mathew also needed plasma injections to help treat his rare coagulation disorder and balance the blood thinners. Mathew's coagulation disease causes him to have bleeding and clotting complications at the same time. Dr. Torres had to find the balance to not tip the scales on either side. The treatment of anticoagulant blood thinner injections and plasma injections worked and Mathew is doing incredibly well today, completely off all medication.

“I was shocked,” Lopez said. “I didn’t know children could have strokes.”

This is a common misconception. The National Stroke Association says stroke happens in about 1 in 4,000 live births and the risk of stroke from birth through age 18 is almost 13 in 100,000 children per year.

The Cook Children's Comprehensive Stroke and Thrombosis Program, one of 16 such centers in the U.S., is led by Dr. Torres and Acosta with additional support from neurosurgery, neuro-radiology, neuropsychology, a dedicated nurse practitioner, nurse, social worker and Child Life specialist. The team is committed to the early recognition, treatment and prevention of pediatric stroke through research, innovation and education. As members of the International Pediatric Stroke Society, the Cook Children's team works with a network of other pediatric hospitals to improve stroke care worldwide.

And yet, unless it happens to your child, most of us never think of children having a stroke.

Strokes in adults are often brought on by lifestyle choices such as high cholesterol, a history of smoking, too much alcohol and obesity. For children, strokes are usually caused by heart birth defects, infections such as meningitis and encephalitis, brain blood vessel abnormalities trauma and blood disorders such as sickle cell disease

“The difference with children and adults in stroke recovery, is that some children with stroke may have a greater capacity for recovery compared to adults; however, this is not the case for all children,” Dr. Acosta said. “Therefore, a comprehensive stroke program similar to that at Cook Children’s Medical Center, is focused on all aspects of stroke care including acute treatment and post stroke recovery. With the help of physical, occupational and speech therapy, childhood stroke survivors may show surprising recovery in lost function. Ongoing assessment of a child’s learning ability with recommendations for school are particularly important to a child’s success.”

“A problem with pediatric strokes, in contrast to those in adults, is that in pediatric strokes, the causes and circumstances are incredibly diverse,” said Dr. Torres. “and they are also widely different within the pediatric age groups. The potential causes of stroke vary radically from a neonatal stroke to the stroke that affects a teenager/young adult.” The team of physicians from the Stroke and Thrombosis Program at Cook Children’s Medical Center work together to give these children up to date therapy and care.

And yet, unless it happens to your child, most of us never think of children having a stroke.

“Unfortunately pediatric strokes have been ignored for a long time as a true entity,” said Fernando Acosta Jr., M.D., associate director of Cook Children’s Pediatric Neurorehabilitation and Movement Disorder Program. “This has changed over the last few years. The awareness is increasing.”

Strokes in adults are often brought on by behavior such as cholesterol, high cholesterol, a history of smoking, too much alcohol and obesity. For children, strokes are usually caused by birth defects, infections such as meningitis and encephalitis, trauma and blood disorders such as sickle cell disease.

“A problem with pediatric strokes, in contrast to those in adults, is that in pediatric strokes, the causes and circumstances are incredible diverse,” said Marcela Torres, M.D. medical director of Hematology at Cook Children’s. “For example, the physicians at Cook Children’s Stroke Clinic see children from 0 to 18 years. Additionally, the potential causes of stroke vary radically from a neonatal stroke to the stroke in a teenager/young adult.

Related Disabilities

Stroke-related disabilities is another area where childhood and adult stroke survivors can differ.

While strokes in children can be devastating, the good news is children often have a better ability to heal because of the greater plasticity or flexibility of the child’s nervous system and brain. A child’s brain is still developing, therefore it may have a greater ability to repair itself. With the help of physical and speech therapy, most childhood stroke survivors recover the use of their arms, legs and speech.

Symptoms of a stroke

The most effective stroke treatments must be given within the first three hours after stroke symptoms start. By recognizing signs of stroke in children and acting fast, you can help medical professionals lessen a stroke’s damage to the child’s brain. Use the following tool to help you think F.A.S.T.:

For more information:

Approximately six in 100,000 children are affected by stroke. Here in the U.S., it is a leading cause of death among children. Nearly 60 percent of childhood strokes occur in boys. Because the causes and symptoms are so different, treating stroke in children requires specialized training, such as what they will receive at the Cook Children's Stroke and Thrombosis Program.