is Your Child's Heart Health?
Healthy Advice from Children's Healthcare of Atlanta
newborns heart may be small, about the size of a strawberry,
but it is powerfulmost of the time. How powerful, energetic
and healthy is your childs heart? If you have not asked yourself
that question, you should.
at the Children's Healthcare of Atlanta Sibley Heart Center help
thousands of newborns, children and teenagers with heart defects
each year. Robert M. Campbell, M.D., Chief Medical Officer at the
Childrens Sibley Heart Center and Director of Sibley Heart
Center Cardiology, often receives the questions below from parents
of patients who visit his office. The Sibley Heart Center Cardiologists
offer the following advice about heart health for children:
common are heart problems in children?
Heart Disease (CHD) is the most common birth defect, with approximately
one out of every 100 infants exhibiting some abnormality of the
heart. These can be minor, symptom-free cardiac abnormalities, but
also can range to extreme life-threatening heart disease affecting
even the fetus. Approximately 40,000 children are born each year
in the United States with CHD, a number that would fill Chicagos
Wrigley Field to maximum capacity.
is a heart murmur, and what does it mean?
to popular belief, a heart murmur does not necessarily equal heart
disease. A heart murmur is simply the noise of turbulent blood flow
heard with a stethoscope through the patients chest wall.
This can be likened to the noise that a mountain stream makes. When
flowing smoothly, there is no noise, yet the same water downstream
flowing over the rocks and rapids makes a lot of noise. A murmur
is a noise of turbulent blood flow. In the cardiologists office,
the important question is, What is causing the turbulence
children have innocent murmur, which is simply the noise of normal
turbulent blood flow inside a normal heart. In this case, a heart
murmur does not indicate any heart disease or a heart problem at
all. In other patients, a heart murmur may be the first sign of
a heart defect, including the so-called hole in the heart,
valve blockage, valve leakage, or abnormalities of the heart muscle.
Further evaluation in the cardiologist office with history, exam,
and occasionally tests including EKG, chest X-ray, and/or echocardiogram
(ultrasound of the heart) may be warranted to completely define
the cause of your childs murmur.
should I do if my child has chest pain?
pain is one of the more common reasons for referral to a pediatric
cardiologist office. However, chest pain in pediatric patients is
rarely caused by a cardiac abnormality. The most common causes of
pediatric chest pain are: chest wall musculoskeletal pain, stress/anxiety
pain or idiopathic growing pains.
wall pains are usually characterized by tenderness in one specific
point, pain that is relatively sharp or stabbing in nature, or pain
that is made worst with deep breathing or pressure over the area
of tenderness. The chest pain may last for seconds to minutes and
may be associated with certain activities.
Stress or anxiety related chest pain is more difficult to characterize
but may be very chronic in nature and is not generally associated
with other specific objective abnormalities on exam.
Growing pains simply means that thorough evaluation found no specific
cause for the pains. This does not mean that the child is not experiencing
chest pain, but rather that no dangerous or worrisome cause has
been detected. Simple reassurance to the patient and the family
Patients with persistent chest pain should undergo evaluation by
a pediatric cardiologist. Chest pain associated with other exercise-related
symptoms, such as shortness of breath, nausea, dizziness and/or
fainting requires immediate attention.
do I do if my child has dizzy episodes or passes out?
with sudden standing or fainting is a common reason for referral
to a pediatric cardiologist. Dizziness or fainting associated with
upright position (sitting or standing) and preceded by warning signs
of light-headedness, visual change, abdominal pain or nausea may
suggest that the patient has low blood pressure and/or low heart
rates as the cause. This can generally be detected by careful examination
in the pediatricians office and/or cardiologists office.
However, patients with sudden onset of fainting with no warning,
passing out during exercise, or passing out resulting in injury
should raise the possibility of other more serious heart muscle
and/or heart rhythm abnormalities. A family history that reveals
multiple family members with unexplained fainting or seizure disorders
should raise the possibility of genetically acquired cardiac conditions
that may place patients at risk for sudden cardiac death. These
patients definitely should be evaluated by a pediatric cardiologist
familiar with a diagnosis of these rare conditions.
do I do if my child feels palpitations or an irregular heart beat?
children and adolescents will report the sensation of fluttering
of the chest or irregular heart beats. An irregular heartbeat does
not necessarily indicate that there is a dangerous abnormality present.
There are many benign causes of an irregular heartbeat.
often includes resting EKG and then home EKG monitoring to determine
the heart rate and rhythm during the symptomatic events. Frequent
causes of irregular heartbeat of children include early beats in
the upper chambers (atrial premature beats) or lower (chambers (ventricular
premature beats) of the heart. These often are benign but may warrant
further evaluation. Other patients may have abnormal fast heart
rates from the upper chambers of the heart (supraventricular tachycardia,
or SVT). These patients may need daily medications or other more
definite cardiac catheterization procedures.
do I protect my child from Sudden Cardiac Death?
Cardiac Death in children is an extremely rare event, but is a high-profile
and emotional community event. Every parent wants to know how to
protect their children from causes of sudden cardiac death. The
causes of sudden cardiac death are multiple, and each is absolutely
uncommon. However, many of the causes are genetic, and therefore,
may be present in multiple family members.
patients who suffer a sudden cardiac death will have experienced
some symptoms. These include: fainting or seizure during exercise,
emotion or startle; unusual or atypical chest pain, especially during
exercise; excessive and unexplained shortness of breath with exercise;;
unexplained heart murmur or high blood pressure. Families that have
unexplained and unexpected premature death from cardiovascular disease
and a close relative younger than 50 years of age should be considered
a suspect. Families that have histories of genetically acquired
disease causing sudden cardiac death should undergo careful and
extensive evaluation. Patients or families with the above-mentioned
symptoms should be evaluated thoroughly by a cardiologist trained
in a differential diagnosis of pediatric sudden cardiac death and
for treatment of any of these disorders.
my childs school have an Automated External Defibrillator
25 percent of the United States population spends part of their
day in school. Having an AED and an effective program at the school
can save lives. An AED program insures that there is an organized,
efficient response to sudden cardiac collapse for students, visitors,
parents and teachers. An AED program also stresses that student
athletes should have thorough standardized pre-participation sports
physical evaluations to screen for causes of sudden cardiac death,
as well as to provide ongoing education for teachers, coaches and
administrators about the warning signs and causes of sudden cardiac
death. Childrens Healthcare of Atlanta recently implemented
Project SAVE (Sudden Cardiac Death, Awareness, Vision for Prevention,
and Education) to educate schools about the many components of implementing
an effective AED program.
is recommended that adults exercise 20 minutes, 3 times a week to
help maintain good heart health. Is this the same recommendation
The American Heart Association recommends that all children age
two years and older should participate in at least 30 minutes of
enjoyable, moderate-intensity activities every day. They should
also perform at least 30 minutes of vigorous physical activities
at least three to four days each week to achieve and maintain a
good level of heart and lung fitness. If there is not a full 30-minute
activity break for the child the vigorous activity can be done in
two 15-minute bouts or three 10-minute bouts. Remember these times
are minimums; the benefits of physical activity generally increase
with increased time spent being active and with intensity. It is
important to note that children need more vigorous activity than
is clear that healthy physical activity is a learned behavior, so
physically active parents are more likely to have physically active
children. While it is important to have physical education in school
and organized sports and recreational activities, this may account
for only a minimal amount of time. Participation in a competitive
sport with one practice and one game per week falls short of the
minimal recommended physical activity.
weight maintenance along normal growth curves or even weight loss,
it is important to remember that physical activity is the calories
used side of the equation and perhaps is more important than
caloric limitation. Older kids and adolescents might be encouraged
to increase physical activity by using a simple electronic pedometer
(cost about $20) with a goal of achieving at least 10,000 steps
are some heart healthy foods that children will actually eat?
healthy foods that are delicious and nutritious are readily available.
Several good sources of nutritional information are available: An
Eating Plan for Healthy Americans from the American Heart
and the We Can! program from the National Heart Lung
and Blood Institute of the National Institutes of Health (www.nhlbi.nih.gov).
exercise, healthy eating habits are learned behaviors. Exposure
to fruits rather than sweets or baked items teaches healthy habits.
Likewise, vegetables should be a part of every days eating
plan. Children should receive five or more servings of fruits and
vegetables per day. These are good sources of vitamins, minerals,
and fiber with few calories. Dairy products with their rich supply
of vitamins, protein, and calcium are important, but get the benefits
from skim or ½ percent milk and low-fat cheeses and yogurts
or nonfat or low-fat ice cream. The daily recommendations for dairy
are two or more servings per day for four to eight-year-olds and
four servings per day for nine to18-year-olds). Complex carbohydrates
such as breads, cereals, pasta and starchy vegetables are healthy,
but may become less so with certain added fats in preparation. Read
labels first. Six servings per day are recommended, but this may
be decreased in certain individuals with over-weight issues. Limit
meat, poultry and fish to no more than six ounces per day, but try
to get one to two servings of baked or grilled fish per week. Use
more healthy oils, higher in monounsaturated fat, to help with appetizing
preparation of foods, like lightly oiled pan-frying on occasion.
Finally, limit calories by encouraging cold water over excess juices
and carbonated drinks.
my child need regular blood pressure screening?
Blood pressure should be measured in all children over three years
of age each time they are seen in a medical setting and at least
once per year. Children less than three years of age should have
their blood pressure measured at these times, if they were premature,
have heart or kidney disease, have recurrent urinary tract infections
or disorders of the urinary system, are on medications that raise
the blood pressure or some other conditions.
blood pressure can tip parents off to a variety of illnesses or
may be a consequence of overweight, poor diet or genetic inheritance.
Measuring blood pressure is important since high blood pressure
may not be associated with any symptoms, yet could be causing damage
to the heart, blood vessels, eyes, kidneys and other organs. Monitoring
blood pressure becomes very important in the adolescent, since they
may only seek medical care if they are sick or are receiving sports
clearance physical exams. Adolescence is when primary (genetic)
hypertension first presents, especially in over-weight and physically
of primary hypertension almost always involves increased aerobic
exercise, repetitive resistance training, decreased dietary salt,
decreased caloric intake and weight-loss management. Hypertension
that is not controlled with life-style changes or more significant
hypertension (sometimes due to another cause) may require anti-hypertensive
medications. Further evaluation, including a cardiology evaluation
and echocardiogram may be ordered. There are many safe and effective
medications, but prevention and life-style changes with yearly physical
examinations are preferable.
my child have regular cholesterol checks at the pediatricians
necessarily. There are no national recommendations for universal
screening of all children. In fact, the National Cholesterol
Education Program of the National Institutes of Health recommends
that children over two years of age have a risk assessment that
includes determining if either parent has a high blood cholesterol
(greater or equal to 240 mg/dl without treatment) or if there is
a positive family history of premature cardiovascular disease (before
age 55 in men and before age 65 in women) in a parent or grandparent.
screening has not been advocated, but universal advice to eat a
heart healthy diet (low in saturated fats and high in fiber,) exercise
regularly, manage weight, not smoke and treat hypertension has been
advocated even in those with normal cholesterol.
a parent has elevated cholesterol, then total cholesterol should
be measured in the children. If normal, the measurement should be
repeated in five years. If abnormal, a fasting lipid profile should
be obtained. This test includes total cholesterol, HDL-cholesterol
(good cholesterol), triglycerides, and a calculation
of LDL-cholesterol (bad cholesterol). This will be evaluated
by your childs doctor. Further evaluation and possibly medications
may be needed.
there is a family history of premature heart disease or if the family
history is unknown (adopted children) or for some reason only partially
known, then a fasting lipid profile should be obtained in the children.
If normal, a repeat fasting lipid profile should be obtained in
five years; if borderline, one year. Children with hypertension
and who are overweight also need a fasting lipid profile. Unfortunately,
with the rise in obesity, there has been a significant increase
in the diagnosis of the metabolic syndrome in children
and teens. This is a clinical diagnosis of obesity (especially truncal
or waist distribution) with insulin resistance (elevated insulin),
abnormal lipids (high cholesterol and triglycerides, low HDL-cholesterol),
hypertension, and abnormal glucose metabolism. Individuals with
the metabolic syndrome left untreated often develop Type II diabetes
mellitus and premature heart disease.
do I know that my child has a heart problem?
your child has any symptoms of heart disease (chest pain, palpitations,
dizzy spells or fainting, unexplained seizures, exercise intolerance,
or unexplained heart murmur), further evaluation may be warranted
by a pediatric cardiologist. It is important to know the familys
heart health history to help determine whether or not the family
has disease processes which puts individual family members at risk
for congenital heart defects, sudden cardiac death, or early onset
of adult cardiac disease. Regular check-ups with the pediatrician
can also help monitor your childs heart as it grows and changes.
if I suspect my child has a heart problem?
your childs pediatrician immediately. To speak with a pediatric
cardiologist, contact the Childrens Healthcare of Atlanta
Sibley Heart Center physicians at 404-256-2593 or 800-542-2233available
24 hours a day, seven days a week.
information presented on this site is intended solely as a general
educational aid, and is neither medical nor healthcare advice for
any individual problem, nor a substitute for medical or other professional
advice and services from a qualified healthcare provider familiar
with your unique circumstances. Always seek the advice of your physician
or other qualified healthcare professional regarding any medical
condition and before starting any new treatment.