Objective: To determine whether lower socioeconomic status (SES) is associated with worse one-year neurological outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS). Methods: From 2010-2014, Vascular Effects of Infection in Pediatric Stroke observational study prospectively enrolled and confirmed 355 children (29 days -18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars (USD)) at time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure (PSOM) scores were categorized as 0-1, 1.5-3, 3.5-6, 6.5-10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. Results: At 12±3 months post-stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<$10,000 USD), but not other markers of SES, was associated with worse outcomes (OR 3.13, 95% CI:1.43-6.88; p=0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI:1.18-8.47; p=0.02). Income did not correlate with receiving rehabilitation services at one-year post-stroke; however, quality and quantity of services were not assessed. Conclusions: In a large multinational, prospective cohort of children with AIS, low income was associated with worse neurological outcomes when compared to those with higher income levels. This difference was not explained by stroke type, neurological comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear, and warrant further investigation.