Does your child have a heart problem? Shelby Kutty, director of Pediatric Cardiology at Johns Hopkins Children’s Center, discusses the signs and symptoms of heart disorders in children, and when parents need to be concerned.

What are the signs of heart problems in children and adolescents?

In watching out for signs of heart problems in children, we look for different symptoms in different age groups. In infants, one sign can be difficulty with feeding, or not growing well, what we call "failure to thrive."

Also, at times, babies with heart problems may experience breathing difficulties — they may breathe rapidly or have to work harder to breathe. A baby with a heart condition may have poor color and appear pale, blue or gray, or seem lethargic.

How about heart symptoms in toddlers?

Concerns for toddlers with an underlying heart condition include poor color and swelling, typically in their face and not their extremities. A less common sign of a heart problem in this age group is failure to thrive, though it can happen. Toddlers with a serious underlying heart disorder may experience breathing problems and fatigue, or difficulty keeping up with other kids their age when playing. Among the most concerning signs in toddlers is syncope, or passing out.

And in school-aged children or adolescents?

Older kids, who can verbally communicate concerns, may complain of chest pain or abnormalities in their heart rhythm, like a rapid or irregular heartbeat. They may also say they experience shortness of breath with normal activities or exercise, and complain of dizziness. Passing out would be included in this age group, too.

Sometimes this scenario is related to something like dehydration — the teen was at the mall all day and didn’t drink any water. It’s important to stress that these symptoms could mean other things and that there might not be anything wrong, but they could be related to a heart condition, too. In such cases, parents may not be too worried but will still take the child to the pediatrician, who may then refer the child to us.

How should parents respond? When should they be most concerned?

The more worrisome scenarios are when syncope occurs during activity without any warning, or when syncope is preceded by an abnormal heart rhythm or chest pain.

Another concern, especially with adolescents, is when the swelling is not limited to the face and appears in the abdomen and extremities too. These are the kids who probably should be evaluated in an emergency room and seen by a pediatric cardiologist.

How do pediatricians tend to manage these cases?

There are variations in pediatricians’ experience and comfort level in managing these cases. Some are just not comfortable making that decision for any complaint that could remotely be cardiac, and they send patients to us. Other pediatricians may take a less aggressive approach, create a differential of possible causes, triage the case and try some initial treatments. If they don’t work, they send the child to us.

In general, though, pediatricians are thinking about cardiac causes — our referral sources are heavily primary care physicians. They’re pretty good at detecting murmurs and getting those kids to us. If the child is otherwise healthy, in their mind, they may think this is less likely to be a pathological type of murmur and will wait a few visits to see if it persists.

For the more severe cases the pediatricians are uniformly pretty good at referring for an urgent evaluation.