Promoting children’s heart health

Heart disease can impact people of all ages — including children.

While many heart problems are discovered at birth, some can show up later.

What symptoms should you watch for in a child? What screenings are recommended for children as they grow?

Eric Johnson, MD, a pediatric cardiologist at PeaceHealth in Springfield, Oregon, shares perspective on both subjects as well as key preventive measures that can help the whole family adopt heart-healthy habits.

Heart issues in young people

While children don’t have “heart attacks” like adults, young people can experience trouble with their hearts. And it helps to have a clear understanding of the categories of heart problems seen in people from birth through adolescence, said Dr. Johnson. One way to categorize pediatric heart problems is as follows:

• Congenital/structural, which is where there's a malformation of a part of the heart.
• Functional, which is where the structure is fine, but the heart is not pumping correctly.
• Electrical, which is when there are issues that disrupt the heart rhythm.
• Acquired, which is when the heart is damaged or impacted by something such an infection or injury.

Some heart problems can start in childhood but may not be diagnosed until adulthood, he noted.

Symptoms of heart issues in children

Regardless of the category, you can watch for symptoms in children according to their age or stage of development.

For newborns, infants and toddlers — basically those who can’t talk yet — the most common symptoms are:

• Failure to thrive
• Difficulty feeding or gaining weight
• Chronic labored breathing when there’s no other explanation
• Lethargic or non-responsive (treat this as an emergency)

Cyanosis, or blue lips, hands or feet, can be related to a heart condition, but in the absence of other symptoms, this is most often not due to a heart condition.

As children get older and can tell you what they’re feeling, you’ll want to watch for:

• Chest pain with exercise
• Heart palpitations
• Exercise intolerance (heavy breathing) that seems out of proportion to the activity level
• Passing out or loss of consciousness, especially with exercise

Recommended heart screenings for children

As in adults, sometimes problems with the heart don’t show up symptomatically so screenings are encouraged as a way to catch early any potential problems that can be treated proactively.

In the US, pediatric heart screenings often start before birth.

A full ultrasound of the fetus is recommended around 20 weeks of gestation, said Dr. Johnson. There are several reasons why a fetus may also need a fetal echocardiogram (an ultrasound specifically of the fetal heart), such as if the unborn child has a first-degree relative who was born with a heart defect.

After birth, babies should have a pulse oximetry screen between 24 and 48 hours of life.  This screen is designed to try to catch some type of birth defects of the heart by measuring the oxygen content in a hand and foot.

Beyond fetal and newborn testing, heart screenings for children include:

• Blood pressure. Pediatricians recommend checking blood pressure at least once a year, starting when the child turns 3 years old. Guidelines require further testing if the reading is high on three consecutive occasions.
• Cholesterol. Guidelines recommend that every child have cholesterol screening done between 9 and 11 years of age and then again between 17 and 21 years of age. If there’s a family history of abnormal cholesterol, screening may be recommended earlier.
• Annual physical.  If your child doesn’t play sports, a regular physical or annual checkup will usually catch something that raises flags or that should be referred to a cardiologist. “A good questionnaire and a thorough physical exam will catch the bulk of important heart conditions.”
• Pre-participation sports screenings. Most experts recommend this type of screening prior to beginning each new level of competitive sports, such as when starting sports in elementary school, junior high, senior high or elite competition.

“Besides trying to catch medical conditions that could be risky or concerning, sports screenings can also be used to prevent unnecessary restrictions,” he said. “These days we're seeing more and more problems with early cardiovascular disease related to atherosclerosis. Because some of that is related to less activity and more screen time, we hope that pre-participation screens can also free up families to feel comfortable participating in sports.”

Heart issues and COVID-19

While the pandemic caused significant delays for adult patients with heart disease, Dr. Johnson’s clinic hasn’t seen similar issues for children with heart issues. What they have seen instead are rare complications from having COVID-19.

“There are rare associations of myocarditis or heart inflammation, both with COVID-19 infection and with the vaccines,” he said. “Based on the most current data, it appears that the problem is a little more common with COVID-19 infection as compared to the vaccines.”

“The vast majority of patients we've seen with it so far have not required hospitalization; it has been mild and has resolved with outpatient monitoring and temporary therapy.”

For children who have had COVID-19, Dr. Johnson encourages parents to talk with their child’s provider — especially if the young person participates in competitive sports. “There are guidelines about gradual return to sports and other red flags might need to be evaluated.”

Steps to promote heart health in children

A lot of what supports good heart health in adults is the same for children – nutrition and physical activity. “They're easy to talk about, but can he hard to implement,” said Dr. Johnson.

“I would add to the list stress reduction. Based on my personal experience, I think children —and teens in particular — are under more and more stress these days, especially with COVID-19. And we know stress has an impact on heart health.”

Dr. Johnson emphasizes that adopting lifestyle changes are the most effective when implemented by the whole family. “The most successful families that I've worked with are the ones that create concrete and specific goals that are in writing and apply to the family,” he said. “They help hold one another accountable and check off on paper whether they reached their goals each day.”

Goals to set

When it comes to nutrition, the doctor encourages whole-food, plant-based diets. Try to eat at least five servings of vegetables and fruits per day and avoid or significantly limit processed foods full of sugar, salt and bad fats. Read more tips on healthy eating for kids.

For physical activity, the American Academy of Pediatrics recommends at least 30 to 60 minutes of moderate to vigorous activity — every day, if possible — or at least five days a week. Explore ideas for staying physically active.

Some common ways to reduce stress in addition to physical activity include sticking to a routine, setting aside time for play, prioritizing friendships, exploring meditation or mindfulness, or talking with a counselor. Learn ways to stress less.

PeaceHealth has a team of expert pediatric cardiologists that can help to diagnose and treat children’s heart conditions. If you have concerns about your child's heart health, schedule an appointment with your pediatrician or a PeaceHealth pediatric cardiologist.