Children's Health and Wellness

Heart Failure in Children

What is heart failure?

The heart is a muscle that pumps oxygen-rich blood to all parts of the body. When you have heart failure, the heart is not able to pump as well as it should. Blood and fluid may back up into the lungs (congestive heart failure), and some parts of the body don’t get enough oxygen-rich blood to work normally. These problems lead to the symptoms of heart failure.

What causes heart failure in children?

The most common cause of heart failure in children is a heart defect that is present at birth (congenital). Other causes include:

  • Heart muscle disease or enlargement of the heart muscle (cardiomyopathy)
  • Decrease in the blood supply to the heart (ischemia). This is rare in children.
  • Heart valve disease
  • Irregular heartbeats (cardiac arrhythmias)
  • Low red blood cell count (anemia)
  • Infections
  • Medicine side effects, especially from drugs used to treat cancer

What are the symptoms of heart failure in children?

Symptoms can occur a bit differently in each child. They can include:

  • Swelling (edema) of the feet, ankles, lower legs, belly, liver, and neck veins
  • Trouble breathing, especially with activity including rapid breathing, wheezing, or excessive coughing
  • Poor feeding and weight gain (in infants)
  • Feeling tired
  • Excessive sweating while feeding, playing, or exercising
Older children may also have:
  • Weight loss
  • Passing out
  • Chest pain

How severe the symptoms are depends on how much of the heart's pumping ability is affected.

The symptoms of heart failure can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is heart failure in children diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. The provider will look for signs and symptoms that may mean heart failure. If the provider thinks your child has heart failure, your child may need to see a pediatric cardiologist. This is a doctor with special training to diagnose and treat heart problems in children. Tests for heart failure may include:

  • Blood and urine tests. Abnormal results may help find heart failure.
  • Chest X-ray. The X-ray may show heart and lung changes.
  • Electrocardiography (ECG). The ECG may show changes in the heart's rhythm.
  • Echocardiography (echo). Ultrasound waves are used to study the motion of the heart's chambers and valves. The echo may show changes caused by heart failure.
  • Cardiac catheterization. The doctor puts a small, flexible tube (catheter) into a blood vessel and moves it to the heart. This measures pressure and oxygen levels inside the heart.

How is heart failure in children treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

If heart failure is caused by a congenital heart defect, correcting the defect may cure heart failure. Medicines are often used to treat heart failure in children. They may include:

  • Digoxin. This is a medicine that can help the heart beat stronger with a more regular rhythm.
  • Water pills (diuretics). These help the kidneys get rid of extra fluid that may build up in the body.
  • ACE (angiotensin-converting enzyme) inhibitors. These medicines help open the blood vessels and lower blood pressure. This makes it easier for your child's heart to pump blood to the body.
  • Beta blockers. These help lower the heart rate and blood pressure. This also makes it easier for the heart to pump blood to the body.

Other treatments include:

  • Pacemaker. Some children with heart failure need an artificial pacemaker. The pacemaker may help when the heart is not pumping well because of a slow heartbeat.
  • Cardiac resynchronization therapy. This uses a special type of pacemaker. This treatment may be used in some children with long-term heart failure.
  • Heart transplant. Children with severe heart failure may be helped with special devices and equipment. These may be used while a child is waiting for a heart transplant.
Children may also need the help of a nutritionist who can help with feeding and managing fluids. Older children may benefit from an exercise rehab program.

What are the complications of heart failure?

Heart failure can cause many complications. These include:

  • Poor growth and development
  • High blood pressure in the blood vessels between the heart and lungs (pulmonary hypertension)
  • Irregular heartbeats (arrhythmias)
  • Blood clots. If a clot blocks the blood supply to the brain, a stroke may occur.
  • Organ damage in the kidney or liver
  • Low red blood cell count or low hemoglobin level (anemia)

Living with heart failure

How well your child lives with heart failure depends on many things, including his or her age. It also depends on how severe the symptoms are and what the treatment is. Your child’s healthcare provider will check him or her often. Some pediatric heart centers have special programs for heart failure. Your child may need:

  • Daily medicines
  • Nutritional supplements
  • To work with the cardiologist to plan for activity and exercise

When should I call my child's healthcare provider?

Call your child's healthcare provider if your child's symptoms get worse. These include:

  • Trouble breathing
  • Swelling (edema)
  • Feeling tired
  • Not eating well

Key points about heart failure in children

  • Heart failure means your child's heart isn't able to pump as well as it should.
  • The most common cause of heart failure in children is a congenital heart defect.
  • Common symptoms in children include trouble breathing, tiredness, and poor growth.
  • Treatment may include fixing a defect, taking medicines, or using a device.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Print Source: Hsu, DT. Heart Failure in Children: Part I: History, Etiology, and Pathophysiology. Circulatio (2009); 2; pp. 63-70
Print Source: Up To Date. Etiology and Diagnosis of Heart Failure in Infants and Children
Online Source: American Heart Association. Heart Failure in Children and Adolescents
Online Source: National Heart, Lung and Blood Institute. What is Heart Failure?
Online Editor: Metzger, Geri
Online Medical Reviewer: Bass, Pat F., III, MD, MPH
Online Medical Reviewer: Gandelman, Glenn, MD, MPH
Date Last Reviewed: 3/6/2016
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