Children: Strokes Question 11:07:00 Asked By Baroness Rendell of Babergh To ask Her Majesty’s Government what steps they are taking to combat childhood stroke. The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton) My Lords, we support the Royal College of Physicians’ guidelines for the management of strokes in children and our work is centred around those guidelines. As the noble Baroness will know, a small number of newborns are vulnerable to strokes from intracranial bleeding, and are given vitamin K to prevent this. A large proportion of strokes in children occur in those with sickle cell, so we have implemented national antenatal and newborn screening. Baroness Rendell of Babergh My Lords, I thank my noble friend for that Answer. Is she aware that the Government’s National Stroke Strategy for improving adult stroke care makes no mention of childhood stroke care? Is she also aware that 400 children in the United Kingdom succumb to stroke each year and that stroke is one of the top causes of death in childhood in the UK? It is likely that most stroke-affected children will be left with a disability of some sort. Does she agree that parents, family members and teachers should be made aware of stroke symptoms? Baroness Thornton My noble friend is right. The National Stroke Strategy does not refer to children because the majority of the annual 110,000 strokes occur to people over the age of 55. However, the main reason is that the clinical path for dealing with children who have strokes is quite different from that for adults. For example, a child who has sickle cell disease may require repeated blood transfusions and even a bone marrow transplant, so it is a quite different treatment path. That is why we use the Royal College of Physicians’ clinical guidelines on how to treat children with stroke. I read with interest that the Stroke Association has produced a manifesto for children with stroke. We are looking at that and I am very happy to answer questions on what we intend to do about the different proposals in that. Baroness Gardner of Parkes My Lords, does the Minister agree that there are two major problems here? One is awareness of the condition. The Government’s FAST campaign has been very successful, so could they not do something similar for children? Parents and teachers do not know what the problem is. The other problem is that of misdiagnosis. Children taken to A&E in time for an emergency scan are often sent away having been told they have an ear infection. There is a need for training of those receiving children in A&E departments. Baroness Thornton The noble Baroness is quite right. We know that public awareness of how to recognise and deal with stroke in children is an important part of this. Two Department of Health publications, the Pregnancy Book and Birth to Five, now contain specific references to how to recognise stroke in children and how to remedy it. Lord Alderdice My Lords, given the uncommon nature of these catastrophic events and therefore the difficulty of providing services right across the country, would the Government be prepared to consider developing a specific centre of expertise that could use an interactive video system in order to connect with centres around the country to ensure that the long-term rehabilitation of these children is appropriate? It is a complex process and different from that for adults. Baroness Thornton The noble Lord has made an interesting proposal. Two major research projects on stroke are taking place in our major universities, and I think that the noble Lord’s proposal is one that we should take up and that the Stroke Association should take note of. It would be a good use of new technology. Lord Patel My Lords, the Minister referred to the causes of stroke in neonates. Do the Government believe that facilities for the care of neonates are adequate in the London region? Baroness Thornton I have no reason to doubt that they are adequate, but if they are not, I hope the noble Lord might tell me that there is a problem so that we can take it up. Lord McColl of Dulwich My Lords, is the Minister aware that childhood stroke may be as common as childhood cancer, and in many ways just as devastating for the families? Over the past year, the charitable income for childhood cancer in the UK was £224 million whereas that for childhood stroke was only £3 million? Can the Government help in this area? Baroness Thornton We know that in England last year there were 420 cases of stroke in children. Half were caused either by sickle cell or pre-existing heart conditions, but in 10 per cent of cases, as yet we do not what the causes were. That is why research in this area is so important. I am not sure whether the case is yet made for a comparison with childhood cancer, but there is absolutely no doubt that, for those 420 cases, it is devastating both for the child and their family. We need to focus on making sure that diagnosis and treatment are swift and that the rehabilitation process is appropriate to the child. Baroness Masham of Ilton My Lords, is the Minister aware that babies can suffer bleeds in the brain while still in the womb? Baroness Thornton The reason that vitamin K is routinely administered to newborns is because it acts as a prophylaxis in order to prevent bleeding, which can cause strokes in newborns. Baroness Howe of Idlicote My Lords, the noble Baroness mentioned rehabilitation and referred to the Royal College of Physicians’ guidelines on treatment and other rehabilitative needs following stroke. Will she expand a little on what the Government hope to do to improve services in this area? Baroness Thornton The key point about rehabilitation is that, as is the case for adults, it should start as soon as possible. The first few days of assessment of movement, positioning, swallowing, speech and communication have to take place as quickly as possible. What this requires for children is paediatric care as well as the medical care that adults would receive. It is also important that parents are involved in all these processes. The Royal College of Physicians’ guidelines are clear on all these issues. We must improve abilities in movement and speech for children affected by stroke and we have to find ways of helping them to adapt. Their skills in daily activities have to be developed, and of course they must be given social, emotional and practical support following discharge from hospital and during their re-entry into normal life in school. Baroness Tonge My Lords, the Minister mentioned sickle cell anaemia as a cause of childhood stroke. How many trusts, where appropriate of course, have specialists who can deal with sickle cell anaemia? In particular, how many nurses have been trained to advise parents who have children with this condition? Baroness Thornton I do not have that information available, but I should be very happy to find it and inform the noble Baroness and the House. Lord Foster of Bishop Auckland Is the Minister convinced— Baroness Howarth of Breckland My Lords— Lord Hunt of Kings Heath My Lords, we have not yet heard a supplementary question from the Labour side. Lord Foster of Bishop Auckland Is the Minister convinced that there is sufficient research and development in this area? Is she also convinced that there are sufficient specialists? If not, what is she doing about it? Baroness Thornton We are aware of two or three major research projects which we are funding to the tune of just under £1 million, although I shall check that figure. My noble friend will of course know that we are never satisfied with our progress and we are always looking for improvements. We have a strategy for dealing with this, we are monitoring that, and we are determined that we will give the required support to these children and their families.