Medical Conditions

Perinatal and Childhood Stroke

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AHA, NIH, AAP guidelines

Editorial policy

Last reviewed:

If your baby has been diagnosed with or you suspect perinatal and childhood stroke, here is what the evidence says.

The short answer

Stroke in babies and children is more common than many people realize, affecting approximately 1 in 2,500 to 4,000 births (perinatal stroke) and about 2-8 per 100,000 children per year (childhood stroke). Perinatal stroke occurs around the time of birth and may not be noticed until months later when the baby favors one side. Childhood stroke presents more suddenly, similar to adult stroke. Seizures are the most common presenting symptom of neonatal stroke. Rapid recognition and treatment can minimize brain damage and improve long-term outcomes.

Key takeaways

  • Stroke in babies and children is more common than many people realize, affecting approximately 1 in 2,500 to 4,000 births (perinatal stroke) and about 2-8 per 100,000 children per year (childhood stroke). Perinatal stroke occurs around the time of birth and may not be noticed until months later when the baby favors one side. Childhood stroke presents more suddenly, similar to adult stroke. Seizures are the most common presenting symptom of neonatal stroke. Rapid recognition and treatment can minimize brain damage and improve long-term outcomes.
  • Usually normal when: Your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall
  • Call your doctor if: Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

This is one of the most common questions parents ask. Searching for answers means you care.

What Parents Should Know

According to AHA, NIH, AAP guidelines, stroke in babies and children is more common than many people realize, affecting approximately 1 in 2,500 to 4,000 births (perinatal stroke) and about 2-8 per 100,000 children per year (childhood stroke). Perinatal stroke occurs around the time of birth and may not be noticed until months later when the baby favors one side. Childhood stroke presents more suddenly, similar to adult stroke. Seizures are the most common presenting symptom of neonatal stroke. Rapid recognition and treatment can minimize brain damage and improve long-term outcomes. At 0-1 month (neonatal), neonatal stroke most commonly presents with seizures in an otherwise well-appearing newborn, typically within the first few days of life. The seizures often affect one side of the body. Other signs include poor feeding, lethargy, or apnea. Risk factors include difficult or prolonged delivery, maternal infection, blood clotting disorders, congenital heart disease, and dehydration. Some neonatal strokes are not recognized at birth and are discovered later when a baby develops handedness too early or motor asymmetry. It is generally considered normal when your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall. However, you should contact your pediatrician promptly if your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall
Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke
Your baby had a birth complication but neuroimaging was normal and they are developing typically
Your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke
Your child had a stroke, received appropriate treatment, and is progressing well in rehabilitation
Your child with a history of stroke develops new seizures or new or worsening weakness — this requires urgent evaluation for recurrent stroke
Your baby has mild asymmetry in movement that has been evaluated and attributed to positional preference rather than neurological cause
Your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand

When to Seek Immediate Care

  • Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke
  • Your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke
  • Your child with a history of stroke develops new seizures or new or worsening weakness — this requires urgent evaluation for recurrent stroke

By Age

What to expect by age

0-1 month (neonatal)

Neonatal stroke most commonly presents with seizures in an otherwise well-appearing newborn, typically within the first few days of life. The seizures often affect one side of the body. Other signs include poor feeding, lethargy, or apnea. Risk factors include difficult or prolonged delivery, maternal infection, blood clotting disorders, congenital heart disease, and dehydration. Some neonatal strokes are not recognized at birth and are discovered later when a baby develops handedness too early or motor asymmetry.

1-12 months

Many perinatal strokes are diagnosed during this period when parents or pediatricians notice the baby strongly favoring one hand (hand preference before 12 months is abnormal and warrants evaluation), reaching with only one arm, or having tightness in one hand or foot. This pattern, called hemiplegia, is the most common long-term consequence of perinatal stroke. Brain MRI reveals the stroke, which may have occurred weeks or months earlier. Early referral to physical and occupational therapy is critical, as constraint-induced movement therapy (CIMT) can help the weaker side develop.

1-5 years

Childhood arterial ischemic stroke in this age range presents more acutely with sudden onset of weakness on one side, difficulty speaking, facial droop, severe headache, vision changes, or loss of balance. Seizures at onset occur in about 25% of cases. Risk factors include congenital heart disease, sickle cell disease, moyamoya disease, infections (such as varicella), and blood clotting disorders. This is a medical emergency — if you suspect stroke in a child, call 911 immediately. Time-sensitive treatments may be available.

5+ years

Stroke in older children more closely resembles adult stroke. The BE-FAST mnemonic applies: Balance problems, Eyes (vision loss), Face drooping, Arm weakness, Speech difficulty, Time to call 911. Children tend to recover better than adults due to greater brain plasticity, but many have lasting effects including hemiplegia, epilepsy, cognitive difficulties, and behavioral changes. Long-term rehabilitation with physical therapy, occupational therapy, and speech therapy helps maximize recovery. A thorough workup for underlying causes is essential to prevent recurrence.

What to Tell Your Pediatrician

  • Describe when you first noticed perinatal and childhood stroke and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand.
  • Mention if your baby holds one hand in a fist while the other hand is open, or one side of the body seems stiffer or less active than the other.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall
  • Your baby had a birth complication but neuroimaging was normal and they are developing typically
  • Your child had a stroke, received appropriate treatment, and is progressing well in rehabilitation
  • Your baby has mild asymmetry in movement that has been evaluated and attributed to positional preference rather than neurological cause
Mention at your next visit when...
  • Your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand
  • Your baby holds one hand in a fist while the other hand is open, or one side of the body seems stiffer or less active than the other
  • Your baby had neonatal seizures and you have not yet had neuroimaging performed
  • Your child complains of sudden, severe headaches or has episodes of brief weakness
Act now when...
  • Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke
  • Your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke
  • Your child with a history of stroke develops new seizures or new or worsening weakness — this requires urgent evaluation for recurrent stroke

What You Can Do at Home

  • Keep track of when you notice perinatal and childhood stroke — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall — this is generally within the range of normal.
  • At 0-1 month (neonatal), focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke.

Early Signs of Epilepsy in Babies

Seizures in babies can look very different from seizures in older children or adults. Subtle signs may include repeated eye blinking or deviation, lip smacking, cycling leg movements, brief stiffening episodes, or clusters of head drops (infantile spasms). Infantile spasms are a neurological emergency that requires urgent evaluation. Not all unusual movements are seizures - babies commonly have benign tremors and startle reflexes - but any movement pattern that seems involuntary, repetitive, and cannot be interrupted deserves medical evaluation.

Signs of Cerebral Palsy in Babies

Cerebral palsy (CP) is the most common motor disability in childhood, affecting about 1 in 345 children. It results from abnormal brain development or damage to the developing brain, most often before or during birth. Early signs include stiffness or floppiness, delayed motor milestones (not sitting by 9 months, not walking by 18 months), favoring one side of the body, and persistent primitive reflexes. Early diagnosis and intervention with physical therapy can significantly improve outcomes and function.

My Baby Seems to Use One Side More Than the Other

Babies should use both sides of their body fairly equally during the first 18 months of life. While slight preferences can be normal, a consistent pattern of favoring one side - using one arm much more than the other, crawling with one leg dragging, or turning the head predominantly one way - should always be discussed with your pediatrician. Early identification of asymmetry leads to the best outcomes.

Moyamoya Disease in Children

Moyamoya disease is a rare, progressive condition in which the major arteries at the base of the brain gradually narrow, reducing blood flow. The body compensates by forming fragile collateral blood vessels (the "puff of smoke" appearance on angiography that gives the disease its Japanese name). It affects approximately 1 in 100,000 children and is more common in children of East Asian descent, though it occurs in all ethnic groups. Moyamoya puts children at risk for stroke and TIAs (transient ischemic attacks). Surgical revascularization is the mainstay of treatment and can significantly reduce stroke risk. Early recognition and treatment are key to preventing irreversible brain damage.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is perinatal and childhood stroke normal?
Stroke in babies and children is more common than many people realize, affecting approximately 1 in 2,500 to 4,000 births (perinatal stroke) and about 2-8 per 100,000 children per year (childhood stroke). Perinatal stroke occurs around the time of birth and may not be noticed until months later when the baby favors one side. Childhood stroke presents more suddenly, similar to adult stroke. Seizures are the most common presenting symptom of neonatal stroke. Rapid recognition and treatment can minimize brain damage and improve long-term outcomes.
When should I call the doctor about perinatal and childhood stroke?
Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke Your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke Your child with a history of stroke develops new seizures or new or worsening weakness — this requires urgent evaluation for recurrent stroke
When is perinatal and childhood stroke normal?
Your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall Your baby had a birth complication but neuroimaging was normal and they are developing typically Your child had a stroke, received appropriate treatment, and is progressing well in rehabilitation
What causes perinatal and childhood stroke?
Stroke in babies and children is more common than many people realize, affecting approximately 1 in 2,500 to 4,000 births (perinatal stroke) and about 2-8 per 100,000 children per year (childhood stroke). Perinatal stroke occurs around the time of birth and may not be noticed until months later when the baby favors one side. Childhood stroke presents more suddenly, similar to adult stroke. Seizures are the most common presenting symptom of neonatal stroke. Rapid recognition and treatment can minimize brain damage and improve long-term outcomes. Common explanations include: Your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall. Your baby had a birth complication but neuroimaging was normal and they are developing typically.
What should I mention to my pediatrician about perinatal and childhood stroke?
You should mention perinatal and childhood stroke at your next visit if: Your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand. Your baby holds one hand in a fist while the other hand is open, or one side of the body seems stiffer or less active than the other. Your baby had neonatal seizures and you have not yet had neuroimaging performed.
Is perinatal and childhood stroke normal at 0-1 month (neonatal)?
Neonatal stroke most commonly presents with seizures in an otherwise well-appearing newborn, typically within the first few days of life. The seizures often affect one side of the body. Other signs include poor feeding, lethargy, or apnea. Risk factors include difficult or prolonged delivery, maternal infection, blood clotting disorders, congenital heart disease, and dehydration. Some neonatal strokes are not recognized at birth and are discovered later when a baby develops handedness too early or motor asymmetry.
Is perinatal and childhood stroke normal at 1-12 months?
Many perinatal strokes are diagnosed during this period when parents or pediatricians notice the baby strongly favoring one hand (hand preference before 12 months is abnormal and warrants evaluation), reaching with only one arm, or having tightness in one hand or foot. This pattern, called hemiplegia, is the most common long-term consequence of perinatal stroke. Brain MRI reveals the stroke, which may have occurred weeks or months earlier. Early referral to physical and occupational therapy is critical, as constraint-induced movement therapy (CIMT) can help the weaker side develop.
Should I go to the ER for perinatal and childhood stroke?
Seek emergency care if your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke, or if your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke. When in doubt, call your pediatrician's after-hours line for guidance.
Does perinatal and childhood stroke go away on its own?
In many cases, perinatal and childhood stroke resolves on its own, especially when your baby occasionally seems to prefer one hand but uses both hands for reaching and grasping overall. By 5+ years, stroke in older children more closely resembles adult stroke. The BE-FAST mnemonic applies: Balance problems, Eyes (vision loss), Face drooping, Arm weakness, Speech difficulty, Time to call 911. Children tend to recover better than adults due to greater brain plasticity, but many have lasting effects including hemiplegia, epilepsy, cognitive difficulties, and behavioral changes. Long-term rehabilitation with physical therapy, occupational therapy, and speech therapy helps maximize recovery. A thorough workup for underlying causes is essential to prevent recurrence.
AHANIHAAP

References

  1. [1]Ferriero DM, Fullerton HJ, Bernard TJ, et al. Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke. 2019;50(3):e51-e96. AHA
  2. [2]National Institute of Neurological Disorders and Stroke. Pediatric Stroke. NINDS, 2023. NIH
  3. [3]American Academy of Pediatrics. Perinatal Stroke: A Review. NeoReviews. 2019;20(6):e298-e311. AAP

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Perinatal and Childhood Stroke.

Things to mention

  • Describe when you first noticed perinatal and childhood stroke and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand.
  • Mention if your baby holds one hand in a fist while the other hand is open, or one side of the body seems stiffer or less active than the other.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your baby strongly favors one hand before 12 months of age, consistently reaching, grasping, and playing with only one hand
  • Your baby holds one hand in a fist while the other hand is open, or one side of the body seems stiffer or less active than the other
  • Your baby had neonatal seizures and you have not yet had neuroimaging performed

Urgent signs to report immediately

  • Your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke
  • Your newborn has seizures, especially affecting only one side — seek immediate emergency evaluation for possible neonatal stroke
  • Your child with a history of stroke develops new seizures or new or worsening weakness — this requires urgent evaluation for recurrent stroke

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Well-Baby Visit PrepBaby Sign Language GuideEmergency ContactsBaby Tracker

Bottom line

Most cases of perinatal and childhood stroke are normal. Talk to your pediatrician if your child suddenly develops weakness on one side of the body, facial drooping, difficulty speaking or understanding speech, vision changes, or severe headache — call 911 immediately, as this may be an acute stroke.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Related Medical Concerns

Early Signs of Epilepsy in Babies

Seizures in babies can look very different from seizures in older children or adults. Subtle signs may include repeated eye blinking or deviation, lip smacking, cycling leg movements, brief stiffening episodes, or clusters of head drops (infantile spasms). Infantile spasms are a neurological emergency that requires urgent evaluation. Not all unusual movements are seizures - babies commonly have benign tremors and startle reflexes - but any movement pattern that seems involuntary, repetitive, and cannot be interrupted deserves medical evaluation.

Signs of Cerebral Palsy in Babies

Cerebral palsy (CP) is the most common motor disability in childhood, affecting about 1 in 345 children. It results from abnormal brain development or damage to the developing brain, most often before or during birth. Early signs include stiffness or floppiness, delayed motor milestones (not sitting by 9 months, not walking by 18 months), favoring one side of the body, and persistent primitive reflexes. Early diagnosis and intervention with physical therapy can significantly improve outcomes and function.

My Baby Seems to Use One Side More Than the Other

Babies should use both sides of their body fairly equally during the first 18 months of life. While slight preferences can be normal, a consistent pattern of favoring one side - using one arm much more than the other, crawling with one leg dragging, or turning the head predominantly one way - should always be discussed with your pediatrician. Early identification of asymmetry leads to the best outcomes.

Moyamoya Disease in Children

Moyamoya disease is a rare, progressive condition in which the major arteries at the base of the brain gradually narrow, reducing blood flow. The body compensates by forming fragile collateral blood vessels (the "puff of smoke" appearance on angiography that gives the disease its Japanese name). It affects approximately 1 in 100,000 children and is more common in children of East Asian descent, though it occurs in all ethnic groups. Moyamoya puts children at risk for stroke and TIAs (transient ischemic attacks). Surgical revascularization is the mainstay of treatment and can significantly reduce stroke risk. Early recognition and treatment are key to preventing irreversible brain damage.

Types of Seizures in Babies and What They Look Like

Seizures in babies can look very different from seizures in adults. Types include subtle seizures (eye deviation, lip smacking, bicycling movements), tonic seizures (stiffening), clonic seizures (rhythmic jerking), myoclonic seizures (quick jerks), and infantile spasms (clusters of brief body flexion). Any suspected seizure in a baby needs medical evaluation. Video-recording the episode on your phone is extremely helpful for your doctor to determine if it was truly a seizure.

My Baby's Head Shape Looks Abnormal

Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.