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Children Aren't Immune to Strokes

New research finds they're more common than even doctors realize

THURSDAY, Oct. 24, 2002 (HealthDayNews) -- Stroke isn't something generally associated with children.

However, kids can have strokes and they probably occur more often than even doctors realize, new research says.

Two recent studies from the journal Neurology looked at the rates of stroke in infancy and childhood and found the disorder is seriously under-recognized. They concluded that much more research needs to be done on the causes and treatment of stroke in youngsters.

"People don't think about kids having stroke," says Dr. Donna Ferriero, the author of one of the studies and chief of child neurology at the University of California, San Francisco. "It's not even prominent in most doctors' minds."

That's a mistake, she says, because as many as one in 4,000 newborns has a stroke. The rate of stroke in children up to 20 years old was previously thought to be around one or two for every 100,000 youngsters, but Ferriero says the rate is as high as seven in every 100,000 children.

While that's still quite rare, it means that stroke is about twice as common in children as brain tumors are. Each year, about 250 children die from stroke, which occurs when the blood supply to any part of the brain is interrupted.

Ferriero discussed the results of the studies today at a conference in San Francisco.

One of the biggest reasons the problem often goes undiagnosed in children is because most of what is known about stroke comes from studies on adults, and stroke doesn't always cause the same symptoms in children, or if it does, they are not as noticeable, Ferriero says.

"For a 2-year-old with a stroke, her language might be garbled, but then most 2-year-olds have garbled language," Ferriero explains. "Or, in a toddler their gait could become unbalanced." Again, she says, trouble walking isn't unusual for toddlers.

It's even more difficult to diagnose a stroke in newborns because if they can't move one side of their body, it's not very noticeable -- at least immediately. Many newborns have seizures when they have a stroke, but not all do. In the study that appeared in the August issue of Neurology, only 57 percent of the babies had seizures.

Another reason stroke can go undetected in children is because they have a remarkable ability to recover from one, says Dr. Keith Siller, a stroke specialist from New York University Medical Center.

"Children do remarkably well and can often compensate for the injured area," Siller adds.

However, few recover completely. An estimated two-thirds of the survivors have neurological deficits or seizures. And stroke recurs in 20 percent to 35 percent of children who have had one. The death rate for infants and children from stroke is about 6 percent, Ferriero says.

One bright note in the research is that death from stroke among children is down dramatically. Between 1979 and 1999, such deaths dropped 58 percent, Ferriero says.

Ferriero says more research needs to be done so physicians can define the risk factors for stroke in infants and children, find out what causes strokes and hopefully come up with new treatments. Some treatments that are helpful in adults can be harmful to children. Also, she says she'd like to see a standardized set of guidelines developed for diagnosing and treating stroke in youngsters.

The studies were able to identify several risk factors for stroke in children. As in adults, being black is a risk factor for stroke. And, it appears that males are slightly more at risk.

Other risk factors are dehydration, bacterial infections, heart disease, chicken pox or blood clotting disorders. Ferriero says these factors are often passed on from the parents. Also, infants seem to a have higher risk of dying from stroke than older children do.

If you're worried something might be wrong with your child -- for example if he's only using one hand to do everything -- Ferriero says you should push to have your child evaluated by a child neurologist.

"Trust your judgment if you feel something isn't right," she advises.

However, Siller adds that parents need to keep the problem of stroke in children in perspective. "It's still a relatively rare thing," he says.

What To Do

For more information on stroke in children, visit the National Institute of Neurological Disorders and Stroke or the Cleveland Clinic Health System.

SOURCES: Donna Ferriero, M.D., chief, child neurology, University of California, San Francisco; Keith Siller, M.D., neurologist and stroke specialist, New York University Medical Center, New York City; July 2002 and August 2002 Neurology; Oct. 24, 2002, presentation, "Child Neurology: Discoveries and Practice" conference, San Francisco.
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