Pediatric stroke is among the leading causes of death and disability in children. Advances in adult stroke recognition, triage, and management have greatly changed stroke systems of care in recent years. Implementation of successful pathways to pre-hospital and in-hospital triage of suspected stroke cases and widespread use of hyperacute thrombolytic interventions in stroke cases, have been shown to improve outcomes in adult stroke patients in ways that would have previously been unimaginable. Additionally, these management approaches have been continually evolving and changing, particularly with the use of newer antithrombotic medications and thrombectomy techniques. Even in the chronic phase, implementation of novel techniques (such as vagal nerve stimulators or constraint induced movement therapy) have provided measurable benefit to chronic stroke survivors. Adapting and implementing these adult management approaches to children has had initial successes, but their implementation and widespread use remains challenging. A through understanding of pediatric age-related considerations and challenges associated with hyperacute, acute and chronic phases of pediatric stroke management is essential, including diagnostic, therapeutic technical, ethical and system-of-care challenges.

This Research Topic aims to present current challenges faced worldwide in pediatric acute stroke systems of care, from pre-hospital recognition to post stroke-acute rehabilitation. One critical issue is the variability in care standards and access to specialized pediatric stroke services, which can lead to delays in treatment and suboptimal outcomes. Advances in imaging technology and so called ‘hyperacute’ therapies offer promise but are underutilized in pediatric stroke. There is a need to improved rapid response protocols that allow for the rapid and optimal diagnosis and treatment of children with suspected stroke. There is also a dearth of proven rehabilitation techniques to improve recovery in pediatric stroke. This research topic aims to highlight these challenges and explore recent advancements in pediatric stroke management, including innovations in diagnostic tools, therapeutic strategies, and care coordination. By bringing together current research and expert perspectives, we seek to identify effective solutions and establish best practices to enhance the quality and efficiency of pediatric acute stroke care.

This Research Topic welcomes articles addressing the biggest challenges in pediatric acute stroke systems of care. We strongly encourage articles including the following 5 themes:
- Pre-hospital triage and management pathways for suspected pediatric acute stroke
- In hospital pediatric acute stroke pathways and protocols
- Special pediatric considerations for adapting hyperacute and acute treatments, such as thrombolysis, thrombectomy and use of new antithrombotic medications
- Community education and engagement initiatives
- Long term care systems, including rehabilitation, for childhood stroke survivors

Authors are encouraged to submit a variety of article types supported by the journal, and a complete list of article types is available here: https://www.frontiersin.org/journals/stroke/for-authors/article-types

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Challenges in Pediatric Acute Stroke Systems of Care