The aim of this pilot study was to investigate feasibility, tolerability, and effect of modified constraint-induced movement therapy (mCIT) in children with hemiparesis after arterial ischaemic stroke (AIS). Children with chronic hemiparesis and impaired hand function after AIS had mCIT for 2 hours a day, 5 days a week for 4 weeks. Pre- and post-therapy assessments included indices of sensorimotor function, quality of upper limb movement, functional therapy goals, and child and parent interviews. Of eight participants initially recruited, six (one male, five females) completed mCIT (median age 12y 3mo; range 6y 10mo-15y 2mo). Hemiparesis was predominantly spastic in three participants and dystonic in the others; all had severely impaired hand function. After mCIT there were no significant improvements in sensorimotor function or quality of upper limb movement. However, all children improved in individual therapy goals related to functional performance. Children and parents were positive about mCIT. The use of mCIT is a promising intervention for children with chronic acquired hemiparesis. In this severely impaired group functional improvements were seen after therapy despite unchanged sensorimotor measures.