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

This NICE accredited evidence-based clinical guideline 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.
Stroke in Childhood

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.

About 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.

Watch the Stroke in Childhood: My Story, where a parent from the Stroke in Childhood Guideline Development Group talks of her experiences.

Full clinical guideline

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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.

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Amendment as of 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 is NICE accredited and has been developed in accordance with the 2016 RCPCH Guideline development process manual, 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.

The guide promotes the following 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 summary of the clinical guideline has been produced through working with the Guidelines Team to provide a concise overview for GPs on the management of stroke in childhood.

Diagnosis algorithm poster

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This print-friendly algorithm poster provides information on how to identify a potential stroke and activate the acute stroke pathway through to treatment for AIS.

See Downloads below.

Guideline for parents, carers and families of children and young people affected by stroke

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Our lay version is based on detailed clinical guidelines produced for healthcare professionals who are involved in the care of children and young people affected by stroke.

It is designed to help the reader understand what a stroke is, why it occurs, and how children and young people affected by stroke should be treated and cared for.

See Downloads below.

Raising awareness

Want to raise awareness that stroke happens to children and young people? The Stroke Association has produced some posters. See Downloads below.

Join the conversation on Twitter at #childhealthmatters, #stroke, #makemaypurple to improve child health and stroke awareness.