My Child Has a Heart Murmur. Should I Be Worried?

You're sitting at your child's annual checkup. Everything is going great. You've talked about growth, school, sleep, and probably whether your child is eating enough vegetables.

Then your pediatrician listens to your child's heart and says:

"Hmm. I'm hearing a little heart murmur."

And suddenly, you're not thinking about vegetables anymore.

You're thinking about your child's heart.

Is something wrong? Has this always been there? Does my child need surgery? Can they still play sports?

As a pediatrician and pediatric cardiologist, I've had this conversation with many families. And there's something I always want parents to understand:

A heart murmur does not automatically mean your child has a heart problem.

In fact, most heart murmurs in children are completely harmless.

But let's talk about what a murmur actually is, why children get them, and when we need to take a closer look.

First, what exactly is a heart murmur?

When I listen to your child's heart with my stethoscope, I'm listening for the familiar "lub-dub" sounds made by the heart valves closing.

Sometimes, I hear an extra sound. It might sound like a whoosh or a swish between those normal heartbeats.

That's a heart murmur.

A murmur is simply the sound of blood flowing through the heart or nearby blood vessels.

It is not a diagnosis.

It doesn't automatically mean there's a hole in the heart, a damaged valve, or anything else wrong.

It just means we're hearing blood flow.

The important question is why we're hearing it.

Wait. So a heart murmur can actually be normal?

Absolutely!

And this is probably my favorite part of the conversation because I can usually see parents start to relax a little.

Children commonly have what we call innocent heart murmurs.

An innocent murmur is the sound of blood moving through an otherwise normal, healthy heart.

Nothing is broken.

Nothing needs to be fixed.

And the heart is doing exactly what it's supposed to do.

These murmurs are especially common in childhood because children's hearts beat faster, their chest walls are thinner, and sometimes we can simply hear normal blood flow more easily.

An innocent murmur might be heard at one appointment and not at the next.

It might become louder when your child has a fever, gets excited, or has been running around.

And sometimes it disappears as your child grows.

Here's the really good news:

Children with innocent heart murmurs don't need medication, surgery, or activity restrictions because of the murmur.

They can run, swim, play soccer, take dance lessons, and do all the things kids are supposed to do.

Then why would my pediatrician send us to a cardiologist?

Because not every murmur is innocent.

Occasionally, a heart murmur is caused by something different about the structure of the heart.

There might be a small hole between two chambers, a valve that is narrower than it should be, or blood flowing in a direction we wouldn't normally expect.

Some of these conditions are minor and only need monitoring. Others may require treatment.

But here's something important:

We can't determine whether every murmur is harmless just because a child looks healthy.

Some children with heart conditions run around, play sports, and have absolutely no symptoms.

That's why I pay attention to more than just whether a murmur is present.

I'm listening to where the murmur is loudest, what it sounds like, when it happens during the heartbeat, and whether it changes when your child sits, stands, or lies down.

I'm also looking at the whole child.

Are they growing normally? Keeping up with their friends? Getting unusually tired? Having difficulty breathing?

And is there any important family history of heart problems?

All of those details help me decide whether we're hearing normal blood flow or whether we need more information.

What happens at a pediatric cardiology appointment?

This is another question I hear frequently, and I think knowing what to expect can make the appointment much less intimidating.

First, we talk.

I want to know about your child, not just the murmur.

I'll ask about their health, activity level, symptoms, and family history. Then I'll listen carefully to their heart and perform a physical examination.

Sometimes, that's enough to confidently identify an innocent murmur.

Other times, we may need additional testing.

An EKG (electrocardiogram) looks at the electrical activity of the heart.

An echocardiogram, often called an echo, is an ultrasound that allows us to see the heart's structure, valves, and blood flow.

An echo doesn't involve needles or radiation. It's similar to the ultrasound you may have had during pregnancy, just focused on the heart.

Not every child with a murmur needs an echo.

And being referred to a cardiologist doesn't automatically mean your pediatrician thinks something is seriously wrong.

Sometimes, we just need another set of ears with specialized training.

Are there symptoms I should watch for?

Most children with innocent murmurs feel perfectly fine.

But there are some things I want parents to mention to their child's doctor, especially if a heart murmur has been detected.

These include:

• Getting unusually tired or short of breath with activity

• Chest pain or fainting during exercise

• Trouble keeping up with other children

• A racing or irregular heartbeat associated with symptoms

• Poor feeding, sweating with feeds, or difficulty gaining weight in infants

• A family history of certain inherited heart conditions or sudden unexplained death

These symptoms don't automatically mean your child has a heart condition.

But they're worth investigating rather than assuming everything is fine.

And if your child has difficulty breathing, faints during exercise, or develops blue or gray lips, they need prompt medical attention. Severe breathing difficulty, collapse, or persistent blue or gray discoloration is an emergency.

What if my child's murmur wasn't there last year?

This surprises a lot of parents.

They'll tell me, "But nobody has ever heard this before!"

And I understand why that feels concerning.

But innocent murmurs can come and go.

Sometimes they're easier to hear when a child's heart is beating faster. Sometimes they're more noticeable during an illness. Sometimes it's simply a matter of how the child is positioned during the exam.

The fact that a murmur is new doesn't automatically make it dangerous.

It does mean we should evaluate it in the context of your child's age, examination, and symptoms.

And sometimes, the answer really is that your child has a completely normal heart that just happens to be a little noisy.

One of my favorite things about pediatric cardiology

There are plenty of complicated things I love about cardiology.

The anatomy. The physiology. Understanding how the heart develops and functions.

But one of my favorite parts of being a pediatric cardiologist is actually pretty simple.

It's being able to reassure a family.

Because I know what happens when a parent hears something might be wrong with their child's heart.

Even if they've been told it's probably nothing, that word "probably" can stick with them.

They go home. They Google. They start wondering whether their child should be running around at recess or playing basketball.

And as a mom, I understand that.

When it's your own child, reassurance matters.

But I don't want to reassure families just for the sake of making them feel better.

I want to be able to explain why I'm reassured.

I want parents to understand what I'm hearing, what it means, and whether their child needs anything else.

Sometimes we find something that needs to be monitored.

Sometimes we find something that needs treatment.

And sometimes, I get to tell a parent:

"Your child's heart is completely normal."

Those are pretty wonderful appointments.

So, should you worry if your child has a heart murmur?

Here's what I want you to remember.

A heart murmur is a sound, not a diagnosis.

Most heart murmurs in children are innocent. But the right next step depends on the child, the examination, and whether there are any other concerns.

If your pediatrician hears a murmur, ask questions.

Does it sound innocent? Is there anything concerning about the examination? Does my child need to see a cardiologist? Are there any activities we should avoid while we're figuring this out?

You deserve answers you understand.

And your child deserves an evaluation that's thoughtful, thorough, and appropriate for them.

Not every murmur needs an ultrasound.

Not every murmur needs ongoing cardiology visits.

And thankfully, most children with murmurs have healthy hearts.

Sometimes a little extra noise is just that. A little extra noise.

And sometimes, hearing that from someone who spends her days listening to children's hearts makes all the difference.

Looking for a pediatric cardiologist in Louisville?

I'm Dr. Meagan Peek, a pediatrician and pediatric cardiologist in Louisville, Kentucky.

I see children and adolescents for heart murmurs, chest pain, dizziness, fainting, palpitations, and other concerns involving the heart.

I'm currently seeing patients at Direct Pediatrics in Middletown, and one of the things I love about my practice is having the time to really talk with families.

If your child's pediatrician has heard a murmur, or you have questions about your child's heart, I'd be happy to help you figure out what comes next.

Because sometimes the most important thing I can offer is an answer.

And sometimes that answer is:

"Your child's heart is okay."

Meagan Peek, MD

Pediatrician & Pediatric Cardiologist

Direct Pediatrics | Middletown, Louisville, KY