Summary and nursing implications of the latest updates to clinical practice.
Summary and nursing implications of the latest updates to clinical practice
About 400 children in the UK experience stroke each year, leaving many with severe physical and mental impairments. Children may need long-term support, including physiotherapy, speech and language therapy, and support with education.
Many professionals and parents think that strokes affect only older people, and this mistaken belief can lead to delays in diagnosis and prompt treatment.
Better knowledge of the signs of childhood stroke among professionals and parents is needed to minimise the long-term effects of stroke, experts have said.
New multidisciplinary guidelines from the Royal College of Paediatrics and Child Health state that children should receive quicker diagnosis and treatment.
Each child suspected of having a stroke should receive a scan within one hour of arriving at hospital, the guideline adds.
Signs and symptoms
Most children experiencing stroke have difficulties similar to those experienced by adults, including weakness of the face and/or one side of the body, and difficulties with speech.
Children with stroke can present with seizures or fits affecting one part of the body or, rarely, a new onset of sudden, severe headache.
Many children affected by stroke have non-specific signs of illness, such as vomiting or a decrease in level of consciousness.
Causes and risk factors
Stroke in children aged from 28 days to 18 years is associated with existing conditions, most commonly congenital heart disease and sickle cell disease.
Other risk factors include trauma to the head or neck, vascular problems, and infectious diseases, such as chicken pox. Often, there is more than one risk factor. About 10% of cases of childhood stroke have no known cause.
How you can help your patient
In pre-hospital and emergency care, consider using the face, arms, speech, time (FAST) tool to determine stroke in children.
The FAST tool is used to assess whether part of the child’s face is drooping, if the child’s arm is weak or numb, or if the child has difficulties with speech.
If such signs are present, you can take urgent action; if they are absent, do not rule stroke out.
Claire Toolis is a clinical nurse specialist in neurology at Great Ormond Street Hospital for Children NHS Foundation Trust, London
‘The most important message for nurses is that they should be aware of the signs of stroke and that, as soon as they see a child who they think may have had one, they take immediate action.
‘Time is essential in the treatment of stroke and can make a big difference to outcomes.
‘I teach all the general health staff at Great Ormond Street to always use the FAST tool in suspected cases.
‘It is so heartbreaking to speak to parents about how they have had to seek care repeatedly because their child’s arm weakness has been put down to a strain or something similar.
‘Raising awareness among parents is also important because many don’t realise that children can experience stroke.
‘Unfortunately, many families have to fight for the long-term care and support their children need after stroke, and I hope that the guidelines will facilitate extra provision.’