The authors compared hemisphere-based and cognitive-domain-based hypotheses for visual-spatial deficits in children with stroke (n = 33) and children without stroke (n = 43). Children with unilateral left (n = 14) or right (n = 7) injury showed less efficient search for the visual field contralateral to their injury. Right-hemisphere injury was associated with deficient global-level processing and coordinate spatial judgments. Left-hemisphere injury resulted in relatively intact local versus global processing and categorical versus coordinate judgments. Bilateral injury (n = 12) resulted in disruption of visual search across visual fields and relative deficits in global-level processing and coordinate spatial judgments. Recovery of visual-spatial processing in children following childhood stroke is task specific. Certain visual-spatial functions typically mediated by the left hemisphere appear less vulnerable to disruption.