To create a childhood stroke database at a major children's hospital, infants and children with stroke evaluated between 1980 and 2000 were identified by a retrospective review of medical records using ICD-9 codes for stroke and related conditions. Children with acute traumatic brain injury were excluded. This strategy identified 179 children, ranging in age from newborn to 19 years (median, 9.5 years) at the time of stroke onset. Most (157/179; 88%) presented between 1990 and 2000, an average of 14 per year. In 1993, 38 children were identified. Thirty-two children (18%) were less than 1 year of age, and in 56 children, age at stroke onset was not available. Most (63%) were girls (n ฯญ 113), and most were white. Middle cerebral artery territory was the most common stroke location (19%), but location was not identified in many cases (40%). More than 15 different risk factors for stroke were identified, with the more common factors being intrauterine events (21%), congenital heart disease (7%), thrombophilic disorders (3%), arteriovenous malformation (3%), bacterial meningitis (3%), and arterial dissection (3%). However, stroke cause was unknown in many instances. Of 112 cases in which the timing of stroke onset could be determined, 56 were evaluated within 1 day of onset, suggesting early recognition in many cases. These data indicate that childhood stroke occurs commonly and confirm prior observations regarding age distribution, cause, and stroke localization. Stroke databases may facilitate preventive and intervention measures.