SHAH ALAM – Stroke can affect children of any age, from newborns to teenagers, and missing the warning signs can delay treatment and affect their development and quality of life.
Although childhood stroke is rare, the Paediatric Protocols for Malaysian Hospitals, developed by the Health Ministry and the Malaysian Paediatric Association, estimates that between 2.5 and 13 cases occur per 100,000 children each year.
Sunway Medical Centre Velocity (SMCV) consultant paediatrician and paediatric neurologist Dr Tan Jen Ern said Malaysia did not have comprehensive data on childhood stroke, although he encountered around one to two cases a year in clinical practice.
“Paediatric stroke is rare, but rarity does not mean it cannot happen,” he said, stressing the importance of recognising sudden neurological changes and seeking emergency medical attention.
Unlike adults, children may struggle to describe their symptoms, while other childhood conditions can produce similar signs, making stroke harder to recognise.
Older children and teenagers may experience facial drooping, weakness on one side of the body or difficulty speaking, while babies and toddlers may show less obvious signs, including seizures or difficulty feeding.
“Unlike adults, children often cannot describe exactly what they are feeling, and many other childhood conditions can look like a stroke,” Dr Tan said, adding that limited awareness among parents and healthcare professionals could cause the condition to be overlooked.
Parents should seek immediate medical attention if their child suddenly develops weakness on one side, facial asymmetry, difficulty speaking or an unexplained seizure.
“Parents should note the time when the child was last known to be well, because the timing of symptoms can be important in determining emergency treatment options,” Dr Tan said, adding that calling an ambulance could help coordinate the child’s transfer to a suitable facility.
“The nearest hospital is not always the one best equipped for an acute stroke,” he said, explaining that some children might need to be transferred for brain and blood vessel imaging or specialist assessment.
Learn to recognise stroke warning signs
Families can learn more about stroke symptoms and brain health at SMCV’s Brain for Life: The Ultimate Mind & Motion Experience, which will run from Oct 30 to Nov 1, from 10am to 10pm, at the main atrium on the ground floor of Sunway Velocity Mall.
The event will feature the SunMed Kids’ Club FAST Heroes Campaign by the Angels Initiative, which teaches children to recognise stroke symptoms, alongside interactive game stations and a Stroke Mirror experience designed to simulate stroke-related symptoms and help families understand warning signs.
Visitors can also attend a panel discussion on memory loss and early Alzheimer’s disease, receive complimentary consultations with SMCV’s neuroscience consultants and undergo complimentary health assessments, with promotions on selected health screening packages also available.
Understanding the causes and effects
Unlike adults, children who have a stroke usually do not have lifestyle-related risk factors. Instead, stroke may be linked to heart disease, abnormalities of the brain’s blood vessels, blood disorders, infection or inflammation, trauma, and certain genetic or metabolic conditions.
Dr Tan said a child who appeared healthy could still have an underlying condition that had not been diagnosed, adding that abnormalities of the brain’s blood vessels were the most common underlying cause in his clinical practice.
Treatment depends on the cause and the child’s condition. Initial care focuses on stabilising the child, controlling seizures and managing complications, while medication to prevent blood clots may be prescribed where appropriate.
For selected children who meet strict criteria, endovascular thrombectomy — a minimally invasive procedure to remove a clot from a blocked artery — may be considered where the necessary expertise is available.
Identifying the cause is also important because the Malaysian paediatric protocol notes that between 12 and 20 per cent of childhood arterial ischaemic strokes, which occur when an artery is blocked, may recur.
“Recurrence risk is not the same for every child,” Dr Tan said, adding that abnormalities of the brain’s arteries carried a higher risk and that treating the underlying cause and arranging close specialist follow-up could help reduce it.
The effects of childhood stroke can continue long after the medical emergency, affecting learning, communication, relationships and everyday life.
A Malaysian study published in 2025 followed 76 children for at least two years after their stroke and found that around three in four had good neurological recovery and could manage daily activities. However, their overall quality of life remained lower than that of healthy Malaysian children, particularly among those who developed learning difficulties.
“A child may have a relatively good physical recovery but continue to experience difficulties with attention, processing speed, memory, learning, communication, emotional regulation, social participation or confidence,” Dr Tan said.
Some difficulties may only become apparent years later, as children start school and face greater learning and developmental demands. Long-term follow-up and rehabilitation, including physiotherapy, occupational therapy, speech and language therapy and educational support, can help address these challenges as children grow.