Unpleasant sensations of fast or forceful heartbeats are called palpitations. Young children with palpitations usually tell their parents that their heart is “beeping” or “going crazy” or words to that effect. Older children typically are able to describe the feeling more effectively. What is a parent to do?
The most important thing is not to panic unless the child passes out, which is extremely rare. Should this happen, call 911 right away and consider doing CPR.
Abnormal heartbeats in children are fairly common and almost never life-threatening. If possible, put your finger to their pulse in the elbow or the wrist and try to count the pulse rate or put your hand on their chest and try to feel their heart. If the heart rate is abnormally fast due to an abnormal heart rhythm, also known as an arrhythmia, it will be over 180 beats per minute and this is too fast to count. If this happens, take your child to the nearest emergency room.
If the heartbeat is not that high and/or the racing heartbeats are happening in short bursts, it is important to see your pediatrician or family physician, who will do an ECG/EKG, or electrical recording of the heart. If that recording is normal, your physician may recommend a heart monitor, usually a heart event recorder and ask the child to try and “capture” one of the fast heartbeats.
Once the rapid heart rate has been documented by ECG, a heart specialist can determine whether it is an abnormal heart rhythm. Palpitations are almost always due to a heart arrhythmia or an anxiety or panic attack. The heart event recorder can help establish which one it is. Rare glandular problems like thyroid abnormalities form the rest, and can be excluded by a simple blood test.
In these days of busy families and over-worked kids, stress-related anxiety attacks are not uncommon in kids. If the recorder suggests that the palpitations are not due to an arrhythmia, but likely due to stress, your doctor will recommend methods to address them that may involve seeing a psychologist or a counselor to get at the cause of the stress.
It is important to realize that the anxiety attacks are not “brought on” by the child; they happen unconsciously and are disabling and scary to the child. It is important to be sympathetic and help the child through his/her issues. Sometimes families see a diagnosis of anxiety or panic attacks as a stigma and insist on more heart tests because, in their opinion, there is no way their child could be stressed. Unfortunately doing more tests is usually unnecessary, expensive and, more importantly, can make the child feel that there is something seriously wrong, which only adds to his/her stress.
Arrhythmias, on the other hand, are managed with daily medications or a day procedure known as a heart electrophysiology, which tests electrical-function, and ablation, which cauterizes or destroys the spot in the heart causing the abnormal heart beats.
Whether your child has an arrhythmia or stress-related palipitations, consulting your primary care physician right away and relying on the partnership between him/her and the heart specialist is the right way to go.
Seshadri Balaji, M.D.
Professor of Pediatric Cardiology
OHSU Doernbecher Children’s Hospital