Just as it is often the case, children have their own unique ways of describing symptoms that we, adults, would commonly report as palpitations. A teenager may complain of “fluttering” in the chest or “heart racing,” while a 7-year-old may report his “heart is beeping fast.” A toddler or infant likely will say nothing at all, preferring to grab at her chest, refuse to eat, cry, or (gulp) all of the above. A parent is then left to wonder, when should I be worried? In fact, what should I even be worried about? Before scenes from the medical drama, “ER,” flood your mind and cloud your judgement, below is my recommended approach to a child with palpitations.
What is a palpitation?
Typing the word, “palpitation,” into Google quickly provides the following definition: a noticeably rapid, strong, or irregular heartbeat due to agitation, exertion, or illness. I simplify the definition further in my own clinical practice: a palpitation is a heart rate or rhythm that is concerning to the patient. In adults, palpitations, much like chest pain, can occasionally be an early sign of cardiac disease. Most of us know of an elderly relative or neighbor for whom an abnormal heart palpitation occurred before or after a “heart attack.” Fortunately, palpitations in children are often due to more familiar, non-cardiac processes, such as fever, caffeine consumption, exercise, anxiety, low blood sugar levels or anemia. Nonetheless, arrhythmias (abnormal heart rhythms) are certainly possible in otherwise healthy children with no known history of congenital heart disease.
Management at home begins with several questions:
- First and foremost, how does your child look as he/she is having an episode of palpitations? If your child is ill-appearing and/or the episode is persistent, seek medical attention (e.g., call your pediatrician, go to the emergency room, call 9-1-1) immediately.
- How frequently and for how long do episodes last?
- How does an episode begin and end (i.e., sudden onset and offset versus gradual onset and offset)?
- What activity (e.g., exercise, anxiety) or meal (e.g., sugary snack or caffeine-containing drink, such as Mountain Dew) may have come before the episode? Anything in particular seem to start an episode?
- What, if anything, can stop an episode (e.g., coughing, using the bathroom, or prolonged rest)?
- What other symptoms are associated (e.g., dizziness, shortness of breath, throbbing headaches)?
Worrisome responses to the above questions that should prompt an office evaluation by your pediatrician sooner rather than later because it may suggest an abnormal heart rhythm or heart rate include:
- Frequent (more than once a week) or long lasting (minutes or greater) episodes.
- Sudden onset and/or offset of palpitations.
- Initiation and persistence while at rest or after completion of exercise or the elimination of a fever.
- Termination fairly consistently with specific gestures, such as bearing down or coughing.
- Association with other worrisome symptoms, such as fainting, lightheadedness, vomiting, or headaches.
Once at the doctor’s office, the pediatrician will likely sort through the details of your child’s symptoms and do a thorough examination to look for clues that the palpitations may or may not have a true cardiac cause. If the latter is suspected, a referral to see someone like myself, a cardiologist/ arrhythmia specialist, may be deemed necessary.
For further information about UofL Physicians – Pediatric Cardiology, visit the practice website. To learn more about Dr. Lau, visit his physician profile or watch this video. Request an appointment online, or call (502) 585-4802.