Jackson As a parent, it can be hard to know when a child’s health complaint is a minor irritation or a sign of a serious problem. That’s especially true for heart issues. Heart issues are relatively rare in children but require immediate medical attention when they occur. We spoke with Marie Gleason, MD, a pediatric cardiologist at Children’s Hospital of Philadelphia (CHOP), to learn what symptoms could be signs of heart problems, when to see a pediatrician, and when a pediatrician might refer you to a pediatric heart specialist.

Chest pains and heart palpitations

If your child complains of chest pain or an irregular heartbeat, you’ll likely worry something is wrong with their heart. Worry is appropriate, but chest pains and palpitations are common in growing children and not usually cause for concern.

Most chest pains are not related to the heart. Most are due to stretching or irritation of the muscles and bones in the chest. Palpitations are typically a sign of your child’s heart beating slightly faster or harder than usual, or of some extra heart beats from the upper or lower chambers of the heart. All of these are usually harmless and do not indicate a serious heart problem.

That said, some children and young adults do experience irregular or rapid heart rates that are not normal. To rule out a serious problem, make an appointment with your child's pediatrician. Your family doctor will be able to determine whether or not your child should see a pediatric cardiologist for further evaluation and testing.

Fainting (syncope)

Syncope is a medical term for fainting or passing out. A person faints when blood pressure drops and reduces the flow of blood to the brain.

It can be very frightening to everyone when a child loses consciousness. The child can also be hurt by falling when they faint. Fear and fall-risk aside, the majority of children and young adults who pass out don’t have a heart problem. In fact, dehydration is a more common cause of fainting in adolescents. However, all episodes of fainting must be addressed by a physician. Your child’s pediatrician will want to know the specifics of when and where the fainting happened, if your child had eaten that day, and if they were feeling sick or if they felt completely normal before passing out. Most doctors will also order an electrocardiogram (ECG) for anyone who faints.

Heart murmurs

A normal heartbeat makes a “lub-dub” sound that can be heard through a stethoscope. This is the sound of the valves opening and closing to let blood into and out of the heart. A heart murmur is an extra sound after the valve closure sounds. Murmurs often make a swishing or whooshing noise and are caused by blood that’s flowing faster than normal through the heart. This is one of the things pediatricians listen for when they examine a patient with a stethoscope during a routine physical exam.

Heart murmurs are very common and can occur in 1 out of 4 children during their growing years. Most are considered normal, or “innocent,” and don’t require any medical interventions. An abnormal heart murmur, though, may suggest a structural problem or heart defect, which requires further evaluation by a cardiologist.

Should your child see a cardiologist?

Your family doctor may recommended seeing a pediatric cardiologist if:

  • The symptoms occur during physical activity.
  • Your child has had palpitations or chest pains during fainting spells.
  • A close family member has experienced fainting, heart disease or sudden death under the age of 50.
  • There is a family history of Marfan syndrome, aortic aneurysm, or another heart-related condition that can be inherited.
  • Anyone in your family has needed a defibrillator.

If your child is referred to a specialist, the cardiologist will likely require one or more tests, most commonly an electrocardiogram (ECG). An ECG will look at the heart rhythm to see if there are any abnormal electrical patterns. The specialist may also recommend an echocardiogram, which is a targeted ultrasound of the heart, to look for structural abnormalities.

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