Pediatric/Adolescent Stroke

Key Points

• The evaluation and management of stroke in children is conceptually similar to adult stroke; whereas the basic pathophysiology, residual functional deficits, and rehabilitative strategies share common concepts; however, there are many important details that differ significantly, making the management of pediatric stroke a distinct area of expertise.

• Common causes of childhood stroke include congenital heart disease, clotting disorders, metabolic disorders, mitochondrial disorders, sickle cell disease, and focal arteriopathy.

• In the acute management of stroke, the dietitian’s main goal is to ensure optimal nutrition in order to promote healing and prepare the child for physical rehabilitation. Nutritional management in the rehabilitation or chronic phase targets long-term effects of stroke including swallowing problems, immobility, spasticity, limited physical activity, cognitive and behavior changes, limited weight-bearing through the lower extremities, pressure sores, constipation, and gastroesophageal reflux.

• Nutrition support is typically provided enterally rather than parenterally unless the gastrointestinal tract is compromised. An interdisciplinary approach is the most effective method of evaluation of long-term feeding, nutrient intake, and growth monitoring.

• Obtaining accurate growth parameters can be challenging, especially in children with long-term disability. In children with disabilities, triceps and subscapular skinfolds as well as arm-fat area may be better indicators of undernutrition than the standard weight/length or body mass index (BMI)/age chart. Children’s limited food preferences are often one of the biggest challenges for clinicians. Optimal nutritional management of the pediatric stroke patient requires knowledge of childhood-specific nutritional requirements, as well as normal and disease-specific growth and development considerations and cannot be based on adult standards or practices.