How to Know if Your Child Needs to See a Cardiologist

As adults, we usually recognize when something abnormal is happening with our hearts. In fact, we may even know some of the jargon — think palpitations, heartburn and angina. For little ones, though, the words needed to properly describe a heart condition might not come as readily.

So how do you know when your child needs to see a physician? To find out, we spoke with pediatric cardiologist Marie M. Gleason, MD, FAAP, FACC, of the Cardiac Center at The Children’s Hospital of Philadelphia (CHOP). Here, she discusses the symptoms that are cause for concern, when to consult a cardiologist and the questions to ask the child’s healthcare team. 

How do children usually describe heart conditions or abnormalities? Are there words or descriptions parents should be listening for?

Younger children may not be able to express what they are feeling as specifically as adults; if they are old enough to talk (preschool or elementary school age), they often say their heart is “beeping” if it is going fast or skipping. But they can certainly describe feelings of chest pain and discomfort.

Older children and adolescents, on the other hand, can often describe symptoms much as adults will, for example, feeling dizzy, feeling their heart skip or flutter or feeling chest pains.

Parents should also look for changes in a child’s behavior or performance, no matter what words the child uses to describe his complaints: is he more tired, or less able to keep up, compared to how he used to be, or in comparison to other children? Is he having any episodes of fainting? Does he show any paleness associated with being cool or clammy? In addition to a change in overall activity, has he lost weight or had a lasting fever?

Which heart symptoms are typically not cause for concern?

Many children complain of symptoms like chest pain or a fast heartbeat. These symptoms can sound worrisome, but they’re usually not a sign of a cardiac problem.

If a child complains of chest pain, parents should find out if the pain is different (worse or better) if the child moves a certain way or breathes in deeply. If the pain changes with movement of the chest, it is likely a muscle issue and not heart related.

If a child complains that her heart is beating fast, parents should take a pulse rate. If it’s fewer than 100 beats per minute, it is generally not a significant arrhythmia and therefore less likely of concern.

If a teen describes brief dizziness upon getting up quickly, rest assured that this is common in growing teens and is usually treated by drinking more fluids.

No matter the complaint, parents should also look at their child’s coloring and breathing pattern. If those are normal, there’s usually not a cause for concern.

It’s very important, though, that parents let their child’s primary care physician know about the complaint during an upcoming appointment.

What are the symptoms of a serious heart condition that shouldn’t be ignored?

Blue skin (called cyanosis) in a baby signifies a serious congenital heart problem and always needs evaluation.

Babies with blockage of blood flow out of the heart will breathe heavily, not feed well, and be pale or gray; they need immediate evaluation as well.

Children with large holes in the walls between the heart chambers will often breathe faster than normal, and have trouble gaining weight, but are not normally blue or gray in color.

Older children and adolescents who acquire heart problems, like an infection of the heart (viral or bacterial) or other types of inflammation, can have rapid heartbeats, shortness of breath, chest pains and/or worsening of their exercise tolerance.

Any symptoms that occur with exertion or exercise, such as chest pain, palpitations, dizziness or passing out, are cause for concern and need evaluation in a timely manner.

Other red flags to a cardiologist are any symptoms in a child or teen with a strong family history of heart muscle problems, or in children with family members who have known arrhythmias or close relatives under 55 years of age who have a pacemaker or defibrillator. 

Should children with these symptoms be seen by a cardiologist or their pediatrician?

Unless the child is showing signs of a severe heart condition and requires immediate care, it’s best to start with his pediatrician. Children with these symptoms will likely need to be seen by a pediatric cardiologist, but the child’s primary care doctor should be kept informed and can start preliminary testing as necessary.

What kinds of questions can parents ask when they’re trying to determine if it’s necessary to seek medical care for their child?

There are a few questions parents can ask:

• Does the child’s complaint affect what she does or how she functions?
• Is she holding herself back or stopping exercise?
• Does she have symptoms when she is active?
• Can she still continue her usual activities despite symptoms?

Also, if the parent sees a child during a complaint, the parent should:

• Take a pulse rate
• Check to see if the child’s coloring is normal
• Identify if anything is different about the child’s breathing pattern

What should parents keep in mind when seeking out a pediatric cardiologist?

Board certification in pediatric cardiology is a must. And while pediatric cardiologists practice in both hospitals and offices, patients can get equally good care by physicians in either location.

For more information about heart disease in children, visit The Children’s Hospital of Philadelphia’s heart disease awareness month advocacy page.