My child is having heart palpitations: should I be worried?

Just as in some adults, children can have heart palpitations too, where the heart feels like it is beating too hard or too fast, or like it has skipped a beat or even is fluttering. Palpitations may sometimes happen in young children but they are more likely to occur in older children and adolescents. As a parent, you may have felt your child's heart beating hard through their chest, even while they sleep, and are concerned. We asked one of our leading London Paediatric Cardiologists, Dr Alessandro Giardini on how to recognise if your child is having heart palpitations, how to know when not to worry, and when to take your child to the doctor.

How can I tell if my child is having heart palpitations?

Older children and adolescents can tell you if they are having any symptoms of palpitations. They may feel uncomfortable, like their heart is racing. They are old enough to have an awareness of their own heartbeat and can describe how it changes when they are running, feeling excited or exercising.

Younger children will struggle to say that they have palpitations but there are referred signs to watch out for, for example, if your little one is running and playing and then they suddenly stop. Sometimes a young child experiencing palpitations may bring their hands to the chest. Maybe they look very tired and they want to stop playing and sit down on the side.

Very young children can have palpitations but they have no way of expressing this. We have to look at other signs, such as if they go off their feeds, look pale and sweaty and perhaps they are breathing fast. Generally you might recognise that they are not their usual selves.

What are the causes?

Palpitations can be due to arrhythmias, which is an abnormal rhythm of the heart. There are very different varieties of arrhythmias, but the most common ones are generally non-life-threatening unless they last for a long period of time. The heart is not designed to beat fast for a long time and therefore a small minority of these types of arrhythmias can be quite serious, particularly if they last for some time.

What should I do if my child has heart palpitations?

The main thing is to make sure that your child is clinically well, that they are not feeling dizzy and there is no chest pain. If the palpitations resolve within 15-20 mins and your child is well then there is usually no need to run to the local hospital but you should be seen by your GP.

If there is an episode of palpitations where the child has chest pain, is feeling unwell, or is experiencing an episode that doesn’t go away for more than half an hour, you should call an ambulance and go to A&E. Ultimately, it is very important to have an electrocardiogram (ECG) whilst your child is having symptoms so that a very complete diagnosis of the cause of the palpitations can be made.

What kinds of tests would they need?

The first thing is for the doctor to take a very detailed clinical history, which is very important. This helps the doctor to understand the triggers, how frequent they are, if these occur with exercise or stress and if there is a family history of heart disease.

Another important part of the assessment is to check for underlying heart disease. We do that by using an ECG, which is a test that looks at the electricity spreading to the heart.

We may have to make an echocardiogram of the heart if the ECG or the clinical examination are not normal because we might be dealing with a dangerous form of arrhythmia. An ECG traces the heart and provides more information on its rhythm.

Very often, children end up having to wear a heart rate monitor, which stays with them for anywhere between 24-48 hours or up to two weeks. The monitor continues to record the child’s ECG and after a period of time we can see if there are any abnormal rhythms associated with their symptoms.

What are the treatment options?

For the majority of children, once we establish a diagnosis and we know it is not life-threatening, it is generally a case of reassuring the family and monitoring the child’s heart rhythm and symptoms.

If the palpitations are frequent or they last for some time, we may have to prescribe medications to prevent further episodes and to keep the symptoms under control, particularly in young kids where there is no other invasive procedure to try and cure any heart problems.

In cases where older school-aged children have a lot of symptoms or episodes, including chest pains and dizziness, or those who don’t respond to medical treatment, we have the option of doing a keyhole procedure to treat their arrhythmia, called catheter ablation. This procedure is usually done as a day case without the need to spend the night in the hospital. There is around 90 to 95 per cent success rate of the procedure. This treatment can treat the condition so that there are no more symptoms or episodes in your child.

If you would like to discuss your child’s heart health, you can book an appointment to have a consultation with Dr Giardini via video call using our e-Consultation tool. View his availability on his Top Doctor’s profile now.