Does your child ever tell you that their heart is racing, beating funny, fluttering, or skipping beats?
If so, you're not alone. Heart palpitations are a fairly common reason children and teenagers are evaluated by their pediatrician or a pediatric cardiologist.
As a pediatrician and pediatric cardiologist, I see families who are understandably worried when their child starts talking about their heartbeat. Sometimes the explanation is something relatively simple, like dehydration, stress, or an occasional extra heartbeat. Other times, we need to investigate whether an abnormal heart rhythm is responsible.
The good news? Most children who experience palpitations do not have a serious heart problem.
But I also don't want parents to dismiss recurring symptoms or assume everything is anxiety without looking into it.
Let's talk about what palpitations actually are, what causes them, and when your child should be evaluated.
What Do Heart Palpitations Feel Like in Children?
Palpitations are simply an awareness of your heartbeat that feels different than usual.
Children may describe them in lots of different ways:
"My heart is beating really fast."
"It feels like my heart is jumping."
"My heart skipped a beat."
"I can feel my heart pounding in my chest."
"It feels like butterflies in my chest."
"My heart starts racing even when I'm not doing anything."
Some children are very good at describing exactly what they're feeling. Others may have a harder time explaining it, especially younger children.
I've learned that it's important to listen to how a child describes their symptoms rather than immediately assuming what they mean.
A heart that beats faster during exercise is normal. A heart that suddenly starts racing while your child is sitting on the couch watching television is a different situation and deserves a closer look, particularly if it happens repeatedly.
What Causes Palpitations in Children?
There are several possible explanations for palpitations, and not all of them involve a problem with the heart itself.
1. Normal Changes in Heart Rate
A child's heart rate naturally changes throughout the day.
Exercise, excitement, crying, stress, fever, and even standing up can cause the heart to beat faster.
Sometimes children simply become more aware of their heartbeat, especially after physical activity or when they're lying quietly in bed.
This is not necessarily a sign of an abnormal heart rhythm.
2. Dehydration
Dehydration is a surprisingly common contributor to a racing heartbeat in children and teenagers.
When the body doesn't have enough fluid, the heart may need to beat faster to maintain adequate circulation.
This can be particularly noticeable during sports, hot weather, illness, or periods when children aren't drinking enough throughout the day.
3. Anxiety and Stress
Anxiety can absolutely cause physical symptoms, including a racing heart, pounding heartbeat, and chest discomfort.
Stress hormones stimulate the body's natural fight-or-flight response, which increases heart rate.
However, I never want a child or parent to feel that their symptoms are being dismissed as anxiety without an appropriate evaluation.
Anxiety can cause palpitations, but an abnormal heart rhythm can also cause anxiety. Sometimes the two can even occur together.
4. Caffeine and Medications
Caffeine and other stimulants can contribute to palpitations.
Energy drinks, coffee, tea, soda, and some supplements can all play a role.
Certain medications can also increase heart rate or make children more aware of their heartbeat. These include some ADHD medications, decongestants, and asthma medications.
It's important to review everything your child takes, including over-the-counter medications and supplements.
5. Extra Heartbeats (PACs and PVCs)
This is one of the things I frequently discuss with families during pediatric cardiology visits.
PACs (premature atrial contractions) and PVCs (premature ventricular contractions) are extra heartbeats that occur earlier than expected.
Children may describe these as:
A skipped heartbeat
A flutter in their chest
A sudden thump
A brief pause followed by a stronger heartbeat
These extra beats are actually very common, even in otherwise healthy children.
In many cases, they are completely benign and don't require treatment. However, the frequency and pattern of the extra beats, along with the child's heart structure and overall evaluation, help determine whether additional monitoring is necessary.
6. Abnormal Heart Rhythms (Arrhythmias)
Occasionally, palpitations are caused by an abnormal electrical rhythm in the heart.
One example is supraventricular tachycardia (SVT).
SVT occurs when an abnormal electrical circuit causes the heart to beat very quickly. In children and teenagers, the heart rate can sometimes reach 180–220 beats per minute or higher.
Unlike the gradual increase in heart rate that happens with exercise or anxiety, SVT often starts and stops very suddenly.
Children may experience:
A sudden racing heartbeat
Chest discomfort
Dizziness or lightheadedness
Shortness of breath
Fatigue
Occasionally, fainting
SVT is often very treatable, and many children with SVT go on to participate in normal activities and sports.
When Should I Be Concerned About My Child's Palpitations?
Most palpitations in children are not dangerous, but there are certain symptoms and circumstances that make me more concerned.
I pay particular attention when palpitations occur:
During exercise: A racing heart that occurs during physical activity, rather than simply afterward, deserves evaluation.
Along with fainting: Especially if your child faints during exercise or feels like they are about to pass out when their heart starts racing.
With chest pain or shortness of breath: Particularly when these symptoms occur together with a racing heartbeat.
Without an obvious trigger: Repeated episodes that occur while resting or sleeping deserve a closer look.
With a family history of heart problems: Particularly unexplained sudden death at a young age, cardiomyopathy, or inherited heart rhythm disorders.
If your child has palpitations accompanied by fainting, significant chest pain, difficulty breathing, or appears pale, blue, or seriously unwell, seek emergency medical attention. Call 911 for severe or ongoing symptoms.
Even if your child feels fine between episodes, recurrent palpitations deserve an evaluation.
How Are Palpitations Diagnosed?
One of the challenges with evaluating palpitations is that they often come and go.
A child may feel their heart racing for 30 seconds, a few minutes, or longer, but by the time they arrive at the doctor's office, everything may look completely normal.
That's why getting a good history is so important.
During an evaluation, I want to know:
When did the symptoms start?
How often do they happen?
How long does each episode last?
Does the heartbeat start and stop suddenly, or gradually?
Does it happen during exercise, at rest, or when standing?
Does your child experience dizziness, chest pain, or shortness of breath?
Is there a family history of heart rhythm problems or unexplained sudden death?
Depending on the history and physical examination, additional testing may be recommended.
Electrocardiogram (EKG)
An EKG is a quick, painless test that records the electrical activity of the heart.
It allows us to look for abnormal rhythms, electrical conduction abnormalities, and other findings that may help explain your child's symptoms.
An important thing to understand is that a normal EKG does not necessarily rule out an intermittent heart rhythm problem. If the abnormal rhythm isn't happening during the test, we may need additional monitoring.
Holter Monitor or Event Monitor
These are wearable monitors that record your child's heart rhythm while they go about their normal activities.
Depending on how frequently symptoms occur, we may recommend monitoring for 24 hours, several days, or even longer.
One of the most helpful things about these monitors is that children can often press a button when they feel symptoms. We can then compare what they experienced with what their heart was actually doing at that moment.
Can My Child Still Play Sports If They Have Palpitations?
This is one of the most common questions I hear from parents.
The answer depends on what's causing the palpitations.
Many children with benign extra heartbeats or occasional awareness of their heartbeat can participate in sports without restrictions.
However, palpitations that occur during exercise, particularly when accompanied by dizziness, fainting, chest pain, or unusual shortness of breath, should be evaluated before continuing strenuous activity.
If an abnormal heart rhythm is identified, recommendations will depend on the specific diagnosis and whether treatment is necessary.
I don't want children unnecessarily restricted from activities they love, but I also want to make sure they're safe.
What Can Parents Do at Home?
If your child is experiencing palpitations, there are a few things you can do that may help with the evaluation.
1. Keep track of episodes.
Write down when symptoms occur, how long they last, and what your child was doing at the time.
2. Check their heart rate if possible.
If your child is comfortable and you can safely check their pulse during an episode, the heart rate can be helpful information. You don't need to repeatedly check it or make your child anxious about their heartbeat.
3. Pay attention to associated symptoms.
Dizziness, fainting, chest pain, shortness of breath, and unusual fatigue are important details to share with your child's doctor.
4. Encourage adequate hydration.
Make sure your child is drinking enough fluids, especially during sports, hot weather, and illness.
5. Limit caffeine and energy drinks.
Energy drinks are particularly concerning for children and teenagers. I recommend avoiding them altogether.
6. Don't assume it's anxiety.
Stress and anxiety can certainly cause palpitations, but recurring symptoms deserve an appropriate medical evaluation.
When Should My Child See a Pediatric Cardiologist?
If your child is experiencing recurrent palpitations, has an abnormal EKG, experiences symptoms during exercise, or has other concerning symptoms or a family history of heart disease, a pediatric cardiology evaluation may be appropriate.
You don't necessarily need to wait until symptoms become severe to have your child evaluated.
One of the things I love about pediatric cardiology is being able to help families understand what's happening with their child's heart.
Sometimes we identify an abnormal rhythm that needs treatment. Other times, we find occasional extra heartbeats or normal variations in heart rate.
And sometimes, just as importantly, we can reassure parents that their child's heart is healthy.
Pediatric Cardiology in Louisville, KY
I'm Dr. Meagan Peek, a pediatrician and board-trained pediatric cardiologist in Louisville, Kentucky.
After completing my pediatric residency at Norton Children's Hospital, I completed my pediatric cardiology fellowship at Washington University in St. Louis. I've spent years caring for children with a wide range of heart conditions, and I understand how stressful it can be when something doesn't seem quite right with your child's heartbeat.
I'm excited to bring both my general pediatric and pediatric cardiology experience together at Direct Pediatrics in Middletown.
I evaluate children and teenagers for concerns including:
Heart palpitations and racing heartbeats
Abnormal heart rhythms
Chest pain
Dizziness and fainting
Heart murmurs
High blood pressure
Family history of heart disease
My goal is to take the time to listen, understand what's happening, and help families develop a plan that makes sense for their child.
If your child is experiencing palpitations or other concerns about their heart, I'd be happy to help determine whether a pediatric cardiology evaluation is appropriate.
Dr. Meagan Peek, MD
Pediatrician & Pediatric Cardiologist
Direct Pediatrics – Middletown
161 S English Station Road
Louisville, KY 40245
Phone: 502-861-6067
Schedule an appointment with Dr. Peek
This article is for educational purposes and is not a substitute for individualized medical advice or evaluation.