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Pediatric Cardiology—Many Success Stories


We think of heart trouble as something that happens to older people. When a young athlete of 20 or 30 dies of a heart condition, it seems unnatural. So it’s especially difficult—often shocking—for new parents to hear that their baby has been diagnosed with a heart condition.

The good news is that the vast majority of heart troubles—nine out of 10, in fact—in children can be fixed. And some problems are so mild that treatment isn’t even necessary.

How common are childhood heart problems?
About 25,000 infants are born with a heart defect each year. That’s about 8 per 1,000 children. These are called “congenital defects,” meaning they date from birth. The truth is that congenital heart defects almost always begin in the womb, early in the baby’s growth.

About 40,000 children are diagnosed with a heart problem after age 1. Most of these defects are mild, and treatment is often not even required.

During childhood about 2 children per 1,000 will experience problems that affect the heart muscle or heart rate.

Heart murmurs requiring no treatment are found in half of all children of normal health. A very few children will develop heart murmurs that indicate an additional problem that will probably require treatment.

Infections that can cause conditions like rheumatic fever and cardiomyopathy affect only about 1 per 1,000 children. Malnutrition can cause heart damage as well, but that is uncommon in the U.S.

Children very rarely have heart attacks. Instead, their heart problems generally occur as a result of defects in the heart walls or valves, or in placement of the heart itself.

What are the signs?
In some cases, doctors can diagnose a heart defect even before a baby is born. When this happens, a medical team is usually standing by during the birth, ready to handle the problem right away.

If a heart problem isn’t diagnosed at birth or before, then it’s probably the parents who will notice the signs of an infant’s heart trouble:

  • Faster than normal breathing, even when asleep
  • Tiredness and sweating when feeding
  • Blue color in the lips and nails (the color becomes more intense during crying or activity)
  • Slow weight gain and slow growth

What are the risk factors?
Most of the time, it’s difficult to determine the cause of a baby’s heart defect. But there are certain risk factors and syndromes that doctors have been able to identify:

Syndromes. One example is Down syndrome. About half of all infants with Down syndrome have a heart defect. Other syndromes include Turner and Marfan. There are others, but they are rare. There is nothing parents can do to prevent these syndromes, and it’s important to remember that most babies with heart defects don’t have these syndromes.

Other genetic defects: Genes play a complex role in the development of heart defects. Genetic counseling is important for parents who have had a child with a heart defect, especially those who want to know whether future children are at increased risk.

Environmental factors: Some illnesses in the mother, particularly viruses, can sometimes cause heart defects. In fact, viruses cause about 2 percent of heart defects. The German measles (rubella) and AIDS viruses are probably the most well known of the viruses that can cause defects. Mothers with diabetes (which is not a virus) are three times more likely to have a child with a heart defect than women who don’t have diabetes.

Medications are also considered to be environmental factors that can cause heart defects. In general, pregnant women should not take any medication or herbal supplement without discussing it with her doctor.

Diagnosis, treatment have become more precise
The main goal of treatment for children with heart problems is to restore their health using a minimum of procedures. Modern diagnostic procedures enable doctors to pinpoint specific causes of heart defects, which in turn allows them to create treatment plans that are more effective than ever. 

One of the most significant advances in diagnosis of a heart condition was the Doppler-echocardiography. It provides moving images of the beating heart. Doppler-echocardiography was initially used in the 1970s. By the mid-80s, the technique had become so precise that it could show images of the inside of the hearts of infants and children. It could also show images of the heart of a fetus as young as 18 weeks.

Because of advances in diagnosis and treatment, children with heart defects that do need treatment most often experience only a brief hospital stay and go on to live healthy, active lives.

What are the chances it will happen again?
Parents of children with heart defects need to know that in almost all cases, they did nothing to cause the problem, and there was nothing they could have done to prevent it. For families with no other members who have the defect, and with no other risk factors, there’s a 95 percent chance that their next baby will have a healthy heart.

The American Heart Association; C. Neill, E. Clark, C. Clark. The Heart of a Child. Johns Hopkins University Press, 2001.
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