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How is Your Child's Heart Health?
Heart Healthy Advice from Children's Healthcare of Atlanta

A newborn’s heart may be small, about the size of a strawberry, but it is powerful—most of the time. How powerful, energetic and healthy is your child’s heart? If you have not asked yourself that question, you should.

Cardiologists 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 Children’s 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:

How common are heart problems in children?

Congenital 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 Chicago’s Wrigley Field to maximum capacity.

What is a heart murmur, and what does it mean?

Contrary 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 patient’s 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 cardiologist’s office, the important question is, “What is causing the turbulence (murmur)?”

Many 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 child’s murmur.

What should I do if my child has chest pain?

Chest 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”.

Chest 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 is indicated.
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.

What do I do if my child has dizzy episodes or passes out?

Dizziness 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 pediatrician’s office and/or cardiologist’s 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.

What do I do if my child feels palpitations or an irregular heart beat?

Many 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.

Evaluation 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.

How do I protect my child from Sudden Cardiac Death?

Sudden 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.

Many 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.

Should my child’s school have an Automated External Defibrillator (AED)?

Approximately 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. Children’s 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.

It is recommended that adults exercise 20 minutes, 3 times a week to help maintain good heart health. Is this the same recommendation for children?

No. 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 adults.

It 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.

For 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 per day.

What are some heart healthy foods that children will actually eat?

Heart 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 Association (www.americanheart.org) and the “We Can!” program from the National Heart Lung and Blood Institute of the National Institutes of Health (www.nhlbi.nih.gov).

Like 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 day’s 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.

Does my child need regular blood pressure screening?

Yes. 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.

High 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 inactive individuals.

Treatment 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.

Should my child have regular cholesterol checks at the pediatrician’s office?

Not 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.

Universal 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.

If 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 child’s doctor. Further evaluation and possibly medications may be needed.

If 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.

How do I know that my child has a heart problem?

If 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 family’s 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 child’s heart as it grows and changes.

What if I suspect my child has a heart problem?

Contact your child’s pediatrician immediately. To speak with a pediatric cardiologist, contact the Children’s Healthcare of Atlanta Sibley Heart Center physicians at 404-256-2593 or 800-542-2233—available 24 hours a day, seven days a week.

The 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.

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