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Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation

Research and Evidence team
This evidence-based clinical guideline (published 2017) provides recommendations for all UK paediatricians and healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke. You can download the full guideline, key recommendations, algorithm poster and appendices, as well as a guideline for parents and carers at the bottom of this page.

»Ê¼Ò»ªÈË stroke

Stroke is a serious childhood disorder, affecting several hundred children and young people in the UK each year. At least half of survivors have some long term impairment.

The full impact of stroke on the developing brain may only emerge over time, with increasing demands on neurocognitive functions, and on educational and social roles, resulting in widespread and long-lasting impact on personal, family and societal consequences.

»Ê¼Ò»ªÈË the guideline

In 2017 the RCPCH and a multi-professional Guideline Development Group, funded by the Stroke Association and in collaboration with key partners, updated the 2004 Royal College of Physicians (RCP) guideline, Stroke in childhood: clinical guidelines for diagnosis, management and rehabilitation.

The guideline is intended for all involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke.

In this video, a parent from the Stroke in Childhood Guideline Development Group talks of her experiences:

Full clinical guideline

This is the most comprehensive and up-to-date guidance on how stroke care should be provided, covering the whole pathway from identification, diagnosis and management of children and young people with arterial ischaemic stroke (AIS) and haemorrhagic stroke (HS) until their transition to adult care.

This 2017 iteration delivers an update and scope extension, and provides guidance on the identification, diagnosis, management and rehabilitation of children and young people with AIS and HS.

On 1 June 2017, the third recommendation under Acute diagnosis (clinical presentation) on page 24 relating to urgent brain imaging was revised to: "Reduced level of consciousness (age-appropriate Glasgow Coma Scale (GCS) less than 12 or AVPU (‘Alert, Voice, Pain, Unresponsive’) less than V) at presentation".

This clinical guideline has been developed in accordance with the RCPCH Setting standards for development of clinical guidelines in paediatrics and child health.

Key recommendations and guideline summary

Our short guide has 83 key recommendations, extracted from the full guideline. If followed, these will enhance the quality of stroke care in children and young people.

We suggest that the concise key recommendations guide is not read in isolation. Health professionals should always consider the full clinical guideline.

Recommendations:

  • Use the FAST (‘Face, Arms, Speech Time’) criteria to determine stroke in children and young people, but do not rule out stroke in the absence of FAST signs.
  • Ensure that a cranial computerised tomography (CT) scan be performed within one hour of arrival at hospital in every child with a suspected stroke.
  • Use the Paediatric National Institute of Health Stroke Scale (PedNIHSS) and age-appropriate Glasgow Coma Scale (GCS) or AVPU (‘Alert, Voice, Pain, Unresponsive’) to assess the child’s neurological status and conscious level respectively.
  • Identify a named key worker/key point of contact for families, who will remain a key point of contact through transfer from hospital to community or specialist rehabilitation services, and including starting/re-entering school.

To accompany the clinical guideline a has been produced through working with the Guidelines Team to provide a concise overview for GPs on the management of stroke in childhood.

Further resources

You can also download:

  • Diagnosis algorithm poster (print-friendly) - how to identify a potential stroke and activate the acute stroke pathway through to treatment for AIS
  • Guideline for parents, carers and families of children and young people affected by stroke (in English/Welsh) - based on full guideline, to help understand what a stroke is, why it occurs and how children and young people affected by stroke should be treated and cared for
  • Posters from Stroke Association - to raise awareness

Review

An assessment on the need to update the guideline and which section(s) was started in 2020, but delayed. We will publish a revised estimated publication date.

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