At age 3, Bella was a kind child with a caring heart. In 2011 she went to bed after playing in the evening. Suddenly, at 2:00 a.m., Bella woke up very ill. She started vomiting and stated she didn’t feel good. Showing concern for this unusual behavior, Bella’s parents brought her to the emergency room.

After sitting in the waiting room for hours, Bella had a seizure. Her parents alerted the staff, but were not taken seriously until she suffered a grand mal seizure. The CT scan she was finally given was misread. However, the pediatrician on call did not agree with the assessment.

FALLING VICTIM: No one expects that their child—or any child—will suffer a stroke. However, prompt diagnosis could mean the difference between life, disability and death, as it did for 3-year-old Bella. Photo: Janelle Paquette

 

What to watch for

Bella’s parents didn’t know strokes could happen in children. Bella had shown some signs of stroke, but they could also be attributed to other conditions. For a 3-year-old, no one thought: stroke.

Everyone needs to recognize symptoms of stroke in children. If your child shows any of these warning signs, you should call for help immediately.

  • Severe headache, especially with vomiting or sleepiness

  • Weakness, numbness or tingling on one side of the body

  • Difficulty speaking or understanding others

  • Sudden vision loss or double vision

  • Severe dizziness or loss of coordination

  • New-onset of seizures, usually on one side of the body

Bella was taken to another hospital where doctors saw her brain was swollen and recognized Bella had suffered a stroke. They tried multiple procedures to reduce the swelling over the next few days.

What stroke looks like

In children, prompt diagnosis and treatment of stroke can minimize death and disability. The possibility of stroke should be considered, without regard to age. The warning signs of stroke for adults, F.A.S.T., can also be applied to children:

  • Face dropping

  • Arm weakness

  • Speech difficulty

  • Time to call 911

Unfortunately, diagnosis of stroke is often delayed or misdiagnosed in babies, children, and teens because of a lack of awareness that strokes can happen in this age group. According to the American Heart Association, the annual incidence of stroke ranges from 4.6 to 6.4 per 100,000 cases in children per year.

Prevalent, serious risk

During the perinatal stage (last few weeks of gestation through one month) that rate is estimated to be even higher, 1 in 3,500 live births. For perinatal stroke, the symptoms may be missed because they can be subtle. In a newborn, seizures with repetitive twitching of the arm, face, or leg may be an indicator. As the baby ages, one key symptom is showing a hand preference, or only reaching out with one hand before one year of age. While not life threatening, this symptom could warrant a consult with a pediatric neurologist.

In 2011, Bella passed away from complications seven days after her stroke. Sadly, stroke is one of the top 10 causes of death in children. Would Bella’s outcome have been different had her signs been recognized sooner? We will never know. Bella is one of many reminders that prompt diagnosis and treatment of stroke is as critical in children as in adults.