Child Safety Blog

Stroke, an injury to the brain usually caused by a clot of blood that blocks delivery of oxygen to a portion of the brain, is thought of as an adults-only disease. It does happen in children, though, and it's worthwhile for parents to know about it, because the symptoms are frequently misdiagnosed. A father's account in the New York Times tells the story of his son Jared, who had a stroke at age seven. Now, two years later, his brain has mostly recovered, a testament to the remarkable power of children's brains to "rewire" themselves, especially when damage is limited to a discrete area. The most common signs of stroke in children or teenagers include the sudden appearance of:

• Weakness of the face, arm or leg, usually on one side of the body
• Trouble walking due to weakness or trouble moving one side of the body
• Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
• Severe headache, especially with vomiting, sleepiness, or double vision
• Trouble seeing clearly in one or both eyes
• Severe dizziness or unsteadiness that may lead to losing balance or falling
• New appearance of seizures, especially affecting one side of the body and followed by paralysis on the side of the seizure activity.

This list comes from Children's Hospital of Philadelphia (CHOP), which has the first pediatric stroke center in the country. In babies and newborns, the signs of stroke can be more subtle, but include seizures and extreme sleepiness, or unusual favoring of one side of the body. Parents who see sudden onset of these signs in their child should call 911 or get the child to an emergency room with expertise in stroke, and should consider a consult by telephone with the experts at CHOP. The stroke experts say that recognition of stroke is often delayed or even missed in most children. Many kids with stroke syndromes are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses. But the key message is that early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing the risk of a repeat stroke.

A riveting story in the Washington Post tells how a Washington area woman's advocacy in the emergency room likely saved her sick daughter from harm.

Sandra Boodman's article interviews Patricia Dawn about her 4-year-old daughter Brooke's illness, that was eventually discovered to be Kawasaki disease, an unusual heart condition. Brooke got the right treatment in time, but only because of her mother's persistence. Mrs. Dawn refused the recommendation of the emergency room doctors to take her daughter home at 2 a.m. when she wasn't feeling any better but they had run out of things to do. At her insistence, her daughter was hospitalized, and an infectious disease specialist eventually figured out that the red lips, red eyes, fever longer than five days, and swollen lymph node in the neck all were signs of Kawasaki, which affects about 2,000 American children a year.

It was also at the family's suggestion that the infectious disease doctor was brought in who made the correct diagnosis.

The story underlines the importance of having a good advocate present at all times with a patient in the hospital. Even a lay advocate can see when symptoms aren't improving and can insist on action.

I discuss this subject in depth in Chapter 12 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

The Virginia State medical board has reprimanded two obstetricians for how they handled the births of infants that were severely and permanently injured during delivery.

The doctors in question are immune from lawsuit because of a 20-year-old no-fault Virginia program that provides medical care to injured children without requiring a trial while protecting obstetricians from legal action. A consequence of this program was that birth-injury cases would often go unscrutinized and negligent obstetricians could go unnoticed and without reprimand. That is why this an unusual event and the first of its kind in twenty years.

The reprimands do not impose monetary sanction on the doctors, nor do they limit the doctors' ability to practice.

Tripler Army Medical Center must, thanks to the order of U.S. District Judge David Ezra, pay $9 million to the family of Parker Kohl. Parker is a 3-year-old who suffered severe brain damage while being treated at Tipler; he now has an IQ of less than 30, must be fed through a tube, is blind and cannot walk. Judge Ezra found that the hospital was negligent in its treatment of Parker.

This resolution is the best news the family could have hoped for, as they now have the resources to care for Parker's needs.

What happened to injure this child so grievously? Parker was diagnosed with a heart defect shortly after he was born and later developed a respiratory infection that led to hospitalization--except that his condition worsened while he was in the hospital's care, leading to cardiorespiratory arrest and subsequent brain damage. According to Judge Ezra, the hospital staff's failure to monitor Parker and prevent this incident was negligent. This is an example of the importance of attentive hospital care and the disastrous consequences of a lack of such care. What can you do to prevent this kind of thing from happening to you or your child? Only one thing has a real chance of helping, and that is asking questions and speaking out if you notice anything in your care that looks improper or inadequate.