DEAR MAYO CLINIC: My child seems more tired than other kids, they don't keep up like they used to and have complained of chest discomfort when playing or running. Could these be signs of a heart condition?

ANSWER: Symptoms like fatigue or chest discomfort in children are common and often have simple, nonserious explanations. Chest pain is one of the most common reasons children are referred to a pediatric cardiologist, but fewer than 5% of cases are related to the heart. However, symptoms during exercise or a noticeable change in your child's usual activity level may be worth a closer look.

Heart conditions in children can present in several ways. Some are congenital, meaning a child is born with them. Others are acquired and develop later, sometimes after an illness or infection. There are also genetic conditions that may not be obvious at first but can lead to heart problems over time. More severe congenital heart conditions are usually diagnosed soon after birth and may require treatment in the first months of life. Milder forms may not cause symptoms right away and are sometimes found when a murmur is heard or as symptoms develop over time.

Warning signs

Warning signs can look different depending on a child's age. In infants, heart problems may show up as poor feeding, tiring during feeding, poor weight gain, fast breathing or fewer wet diapers. Some babies may seem sleepier than usual or not waking well enough to feed. These symptoms can appear in the first weeks of life, particularly in babies with larger congenital heart defects. 

Because babies can't tell you what they feel, noticing changes in these everyday patterns is especially important and should be evaluated promptly.

In older children, symptoms that occur during physical activity tend to raise more concern. For example, chest pain is more worrisome when it happens during intense exercise, feels like pressure and doesn't change with breathing. It may be especially concerning if the child also experiences shortness of breath, dizziness or fainting during activity. 

Shortness of breath can have several causes in children, but what matters most is whether there has been a change. A child who previously kept up with others but now falls behind, takes more breaks or struggles with activity should be evaluated more closely.

Symptoms

Some symptoms shouldn't be ignored. These include: 

• Passing out, especially during exercise.
• Chest pain with activity.
• Fast heart rate that doesn't slow down at rest.

A racing heartbeat that is difficult to count or doesn't slow after activity should be evaluated right away.

Changes in skin color can be another warning sign. A bluish color around the lips, tongue or inside the mouth may indicate low oxygen levels and should be checked out promptly.

Family history also matters. A history of heart disease in close relatives can increase the likelihood that a child may be affected. Family history is especially important when there's cardiomyopathy or unexplained death, particularly during exercise or sleep. In these cases, children may need screening even if they seem healthy. Some inherited heart conditions don't cause symptoms early in life, so knowing the family history can help identify children who need follow-up. 

If a child is evaluated for a possible heart problem, the visit often starts with a detailed history and a careful physical exam. Depending on the situation, the child may have one or more tests. These may include: 

• An electrocardiogram to assess the heart's electrical activity. 
• An echocardiogram or ultrasound of the heart to evaluate its structure, blood flow and function. 

Not every child will need testing. Sometimes the history and exam suggest a harmless cause, such as an "innocent" murmur, that doesn't require additional tests or treatment. In other cases, these studies help clarify whether there's a structural or rhythm-related problem. 

Most of the time, symptoms in children, such as chest pain, palpitations or fatigue, aren't caused by heart disease. Pediatric heart conditions are relatively rare. Even so, symptoms still deserve attention so that children who need care are identified early, and others can be reassured.

Most children with these symptoms won't have a heart condition, but signs such as fainting, a racing heartbeat that doesn't slow down at rest, or a clear change in activity level shouldn't be ignored. If something feels different or concerning, it's appropriate to have your child evaluated.

Josué Maldonado Custodio, M.D., Cardiology, Mayo Clinic Health System, Eau Claire and La Crosse, Wisconsin

Related Articles