Childhood stroke is emerging as a serious and frequent disorder. In contrast to adult stroke, the study of childhood stroke is in a very early stage of research development with no randomized controlled trials conducted to date outside of sickle cell stroke. The results of research in adults have limited applicability to children with stroke due to fundamental age-related differences in the neurological, cerebrovascular and coagulation systems. In recent years clinical and basic research studies have improved our understanding of childhood stroke. Population-based studies have resulted in an increased awareness of the frequencies and features of stroke syndromes in children. Cohort and case-control studies have led to an enhanced understanding of the multiple risk factors underlying childhood stroke. Advances in neuroimaging and in genetic and other laboratory testing approaches have resulted in an increased definition of stroke subtypes and risk factors.