Dawson Quiroz pranced around the mound of bottle caps and glitter in her kitchen before scrambling onto the counter in her princess dress. She paused to peer at the half-made fundraiser necklaces - the most tangible reminder of the past year.
The Frisco 4-year-old suffered a stroke a year ago, leaving her family questioning both the cause and the possibility of recurrence.
"You hear of cancer and leukemia in children, but not strokes," said Dawson's mother, Patti Quiroz. "And then you're told they can't tell you why, just hope it doesn't happen again."
Child strokes - one of the top 10 killers of children - are as prevalent as brain tumors and affect three of every 100,000 children annually. And while technological advances are driving greater recognition of the condition, pediatricians tend to misdiagnose pediatric strokes, and parents often miss warning signs. Research is still in its infancy, with only a handful of studies in the field. The International Pediatric Stroke Study Group is less than 10 years old.
Dawson's parents hope to spur more research and create a support network through Dawson's Cause, a fledgling foundation dedicated to child stroke awareness. They're trying to raise $1 million for Children's Medical Center Dallas through publicity and the sale of homemade necklaces. They already have the sponsorship of a March golf tournament, and at least 10 local shops have agreed to sell their "bling caps," revamped bottle caps with charms inside. Dawson's 7-year-old sister came up with the idea. Quiroz, an American Airlines flight attendant, estimates that she makes 2,000 a week.
It's the family's way of coping with a reality that's still hard to process.
Dawson's parents noticed something was wrong one Saturday when their daughter began tugging on her ear. Then she stopped talking and starting wetting her pants. The next morning Quiroz heard a scream from her husband in the bedroom. Dawson had no equilibrium. She swayed like she was drugged.
"I thought, 'How can this happen?' " said her father, Ruben Quiroz. "It's insane. This is a little girl."
The doctors didn't know. Dawson had suffered an ischemic stroke, a blood clot in the brain. But she didn't have a hole in her heart or conditions like sickle cell anemia that would have predisposed her to one. Child strokes can result from physical trauma such as a snowboarding accident or a bad fall. That hadn't happened, either. She had another stroke several days later.
About 40 percent of the time the cause remains unknown, said Michael Dowling, Dawson's doctor and the medical director for the Pediatric Stroke Program at Children's Medical Center Dallas. Research teams are now learning more about the relationship between illness, infections and strokes in children, he said. But Dawson had been to the doctor for a check-up that week and was considered in good health.
Child strokes "often don't come up on the radar in pediatricians' minds because they're so unusual," Dowling said. "We are battling to increase that recognition as much as possible."
A Kaiser study released last fall found that about twice as many children had strokes than estimates suggested. Researchers say that's largely because of more notice, not higher rates. Stories like the one a New York reporter told about his 7-year-old son are bringing attention to the problem.
But comprehensive guidelines for pediatric strokes only came out in 2008, when the American Heart Association expressed concern about a disparity in treatment. The National Institutes of Health is just now funding its first study on child strokes. Children's, which sees about three child strokes a month, is participating. More children are enrolled from the Dallas hospital than anywhere else in the country. Dawson is a case study.
Doctors do know that the plasticity of children's brains aids recovery. Mortality rates are only 10 percent, although the American Heart Association says there's more than a 40 percent chance survivors will face neurological difficulties for the rest of their lives.
The Quiroz family still doesn't know the effect the stroke had on Dawson, or whether there will be more. The heart association says that one in 10 children will have another within five years.
"It feels like we live with a china doll," Patti Quiroz said, making sure Dawson didn't fall from her seat on the counter as they colored together.
The energetic girl just got off a blood thinner that made her bleed so easily she had to limit her movements. The preschool suggested she stay home while she took the medicine.
Her cheek has only traces of paralysis, but she's lost the patience and ease she once had. She sometimes repeats desires, "Draw me a rainbow, draw me a rainbow, draw me a rainbow," like she's stuck.
One of the greatest struggles for parents is understanding their child's behavior after a stroke, said Nancy Atwood, the co-founder and president of the Arlington-based Children's Hemiplegia and Stroke Association.
"There's a lot of isolation going on," she said. "You aren't expecting it, you've never heard of it, then you are hit with all these different professionals." About 1,600 families participate in the group on a worldwide list. Parents ask how to deal with limited insurance coverage for therapy or whether to expect a seizure during recovery.
It's that uncertainty the Quirozes want to end with Dawson's Cause.
"It's extremely frustrating as a parent," said Ruben Quiroz, as his daughter giggled behind him. "How the hell in modern society, with all the medical miracles, have we swept this under the carpet?" WARNING SIGNS
FACE: Ask the child to smile. Does one side of the face droop?
ARMS: Ask the child to raise both arms. Does one arm drift downward?
SPEECH: Ask the child to repeat a simple sentence. Are the words slurred? Can the child repeat the sentence correctly?
TIME: If the child shows any of these symptoms, time is important. Call 911 or get to a hospital immediately. Brain cells are dying.
SOURCE: National Stroke Association