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Neurology

Paediatric NIH Stroke Scale (PedNIHSS)

The paediatric version of the NIH Stroke Scale, for children aged 2 to 18.

For education. Check against your unit's guidance and a second clinician before use.

1a. Level of consciousness
1b. Questions

Ask the child's age, and ask them to point to or name a familiar family member who is present.

1c. Commands

Ask the child to open and close their eyes, then to touch their nose.

2. Best gaze
3. Visual fields

In younger children, test with a toy or face brought into each side of the visual field.

4. Facial palsy
5a. Left arm

Arm out at 90° (sitting) or 45° (lying) for 10 seconds.

5b. Right arm
6a. Left leg

Leg raised at 30° (lying) for 5 seconds.

6b. Right leg
7. Limb ataxia

Finger–nose and heel–shin tests. In young children, reaching for a toy and kicking at a hand.

8. Sensory
9. Best language

Use age-appropriate naming and descriptions (the PedNIHSS gives picture and object tasks by age).

10. Dysarthria
11. Extinction and inattention (neglect)

0 of 15 items answered (running total 0). Answer every item to see the score.

Before you use this

  • Higher scores mean a more severe deficit. There are no validated severity bands for children; use the score to describe and track change.
  • The RCPCH childhood stroke guideline recommends the PedNIHSS alongside an age-appropriate GCS. Stroke in children is often missed: if you suspect it, get urgent brain imaging and involve paediatric neurology, following your local childhood stroke pathway.

How this is calculated

  • Fifteen items are scored and added up, from 0 (no deficit) to 42.
  • The paediatric version keeps the adult NIHSS items and scoring, and adapts the instructions for children (for example the questions, commands and language tasks).
  • Untestable items score 0 and are recorded as untestable.

Sources

Checked by PICUlearn, 21 Sept 2026.

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