This review provides an overview of pediatric ischemic stroke to serve as a foundation for the discussion of rehabilitation strategies following focal injury in the developing brain. Cerebrovascular disease is an important cause of acquired brain injury in neonates and children. Ischemic strokes are caused by a multitude of risk factors and advances in neuroimaging have improved diagnosis and understanding of pathophysiology. Pediatric stroke provides the ideal model for the study of injury and recovery in a plastic nervous system. Though their brains likely posses greater potential and unique reorganizational skills, most children suffer neurological morbidity after stroke. An improved understanding of these systems is helping us understand, validate, and improve traditional approaches to rehabilitation while opening the door to new opportunities to improve outcome. All aspects of a patient's function, from the physical to psychological, including issues unique to children and their families, must be addressed and are reviewed. New advances and future directions for research are highlighted.