Australia’s first clinical guidelines for children with stroke

Doctors from the Sydney Children’s Hospitals Network have contributed to the development of Australia’s first ever clinical guidelines that will improve the diagnosis and acute management of children that suffer a stroke, with the aim of speeding up diagnosis when time is critical to minimise brain injury and improve recovery.

Approximately 300 babies and children are diagnosed with a stroke in Australia each year. More than half of the children that survive have long term disabilities that they carry for their lifetime at great cost to themselves, their families and the healthcare system.

These guidelines will be an available reference guide for physicians throughout the country. Stroke in infants and children has many causes, almost all of which are different to usual causes in adults. Good community awareness of stroke in adults and recent advances in stroke care have enabled effective, speedy treatment of stroke in adults, but these pathways cannot be applied to children. The infrequency of stroke, the multitude of causes and the complexities of investigation in children mean diagnosis is often delayed. As a consequence, patients may miss the window for life-changing interventions to minimise brain injury and improve recovery. The guidelines provide more than 60 recommendations to assist emergency staff and paediatricians in diagnosing and managing children with stroke.

Some key recommendations include:

  • Recognising presenting symptoms that require investigation for stroke and separating these from the many disorders which look like a stroke, but are due to different disorders in children
  • The importance of urgent MRI using child-specific imaging protocols for an accurate stroke diagnosis
  • How to acutely manage symptoms and identify those children requiring surgical or complex medical interventions in specialist paediatric stroke and neurology units.

The Ian Potter Foundation funded the initiative. A/Prof Mark Mackay, Paediatric Neurologist, Director of the Royal Children’s Stroke Program and researcher with the Murdoch Children’s Research Institute, chaired the Australian Childhood Stroke Advisory Committee (ACSAC), which included specialists representing each of Australia’s tertiary paediatric hospitals.

The ACSAC members, including paediatric neurologists Dr Ian Andrews, Dr Chris Troedson and Prof Russell Dale from the Sydney Children’s Hospitals Network, volunteered their time and expertise to ensure that these important guidelines are of the highest international quality and can be implemented across the county.

“Although stroke is relatively uncommon in childhood, it is a very serious problem with permanent consequences for the child and family. Stroke is more common in the newborn period and in early infancy, meaning a child who suffers stroke, and their family, will cope with that brain injury for the next 70 years or more,” says Dr Ian Andrews, paediatric neurologist at Sydney Children’s Hospital, Randwick.

“The aims of this guideline are to provide a framework for the accurate and timely recognition of stroke in children, so the advances in acute stroke care and protection from ongoing loss of brain cells by delayed therapy can start to be applied to children as they are to adults.”

The full guidelines will be published in the International Journal of Stroke.

* Image courtesy of the Murdoch Children's Research Institute.