Stories about: Dr. Michael Rivkin

Stroke in kids: What’s different?

pediatric stroke
Illustration: Fawn Gracey

Every May, we recognize National Stroke Awareness Month to honor everyone who has experienced a stroke — and to raise awareness of this disease. That awareness is especially important for pediatric stroke, which is more common than you might imagine. “Stroke occurs throughout childhood, from birth through 18 years of age, and more commonly than people think,” says Dr. Michael Rivkin, co-director of the Stroke and Cerebrovascular Center at Boston Children’s Hospital. “In fact, among newborns, its occurrence is very nearly that of its occurrence in older adults.” Here, he shares four facts parents need to know about pediatric stroke — and how it differs from that in adults.

No1
Kids aren’t immune.

Despite the misconception that stroke is a disease of the elderly, anyone can experience one — including infants and children. Babies can even have strokes while they are still in their mother’s womb. All told, strokes occur in an estimated 1 in 2,500 live births and affect nearly 11 out of 100,000 children under age 18 every year. The risk of having one is highest in a child’s first year of life, particularly during the few weeks before and after birth.

No2
Kids can have different risk factors.

Most of us are familiar with the factors that can raise the risk of stroke in adults, such as cardiovascular disease, an irregular heartbeat, obesity, diabetes and smoking. But children are more likely to experience a stroke for different reasons, says Dr. Rivkin. Common risk factors for pediatric stroke include congenital heart disease, blood vessel abnormalities (such as arterial dissection and moyamoya), disorders that increase the blood’s tendency to clot (such as sickle cell disease), infection or inflammation.

No3
Kids can have different symptoms.

In adults, we’ve been taught to look for the most common warning signs — classic symptoms such as facial drooping, arm weakness or numbness and speech difficulties. Although these signs can also be used to help identify the problem in children, kids can exhibit other symptoms as well. Newborns and young children may be extremely sleepy, use only one side of their body and experience seizures. In children and teenagers, severe headaches, vomiting, dizziness and trouble with balance and coordination, as well as seizures, may signal a stroke.

No4
Kids tend to recover better.

Because children’s brains are still developing, they tend to recover better than many adults. Indeed, the problems that result from the stroke (such as weakness and numbness) can often improve over time with therapy. A team approach to pediatric stroke — including child neurologists, hematologists, neurosurgeons, interventional and neuroradiologists, physical and occupational therapists, speech and language therapists, neuropsychologists, educational specialists, and physical and rehabilitation medicine physicians — is optimal. “We understand that a multidisciplinary and intensive approach to care of children with stroke provides the best route to recovery,” says Dr. Rivkin.

Learn about the Stroke and Cerebrovascular Center.

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Banding together: Finding support for pediatric stroke

stroke recovery
Surrounded by his family, Patrick walks unassisted after recovering from a stroke.

Cristina Murphy is the daughter of a cardiologist, but even she wasn’t aware that stroke could occur in children — until her young son Patrick had one. Her vibrant little boy was just a toddler when he was rushed to the emergency room for what his parents and their pediatrician initially assumed was a severe stomach bug. But further testing confirmed the unimaginable: Patrick had experienced a rare bilateral cerebellar stroke.

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Striking a balance: Charlie’s recovery from neonatal stroke

Charlie is making progress recovering from a stroke.

“Hey, Charlie,” says Dr. Michael Rivkin as he gently dangles a small rubber ducky in front of the little boy. “Would you like this?” A wide smile breaks out across the toddler’s face. Why yes, he certainly would like that duck. He reaches and grasps at it, closing his tiny fingers around the toy.

For Charlie Strzempek, it’s nothing more than a playful act. But for his parents, Kathleen and Tom, it’s a major accomplishment. Dr. Rivkin isn’t simply offering his patient a toy. He’s testing his ability to grab and hold an object in his right hand — the side of his body affected by a neonatal stroke.

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Cadagan: Humor and tenacity after a stroke

Treatment for stroke has helped Cadagan thrive.

Most parents try to discourage their children from indulging in humor about bodily functions like burping. But for Daniel and Lori Hooley, a simple smirk in response to a belch was the sign they needed that their daughter, Cadagan, was going to be okay.

It was 2012 and 7-year-old Cadagan was asleep, tucked into bed for the night. Around 11 p.m., she suddenly awoke — but it wasn’t because of a nightmare or a late-night request for a glass of water. Instead, she seemed limp and couldn’t focus. Then she began throwing up. Born with an extremely rare genetic disorder called trisomy 12p, the little girl had already experienced her share of health challenges. But this was something different.

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