Heart murmurs in children are usually nothing to worry about

The Pediatric Insider

© 2013 Roy Benaroch, MD

Here’s a question: “My daughter was found to have a heart murmur at a well check. Is this something I need to worry about?”

A murmur just means a noise—the noise of blood swishing through the heart and blood vessels of the chest. Because children have thin chest walls and very little fat under their skin, murmurs are heard very commonly in kids. About 50% of kids will have a murmur heard at least once during their childhood.

Almost all of these murmurs heard in healthy children mean nothing. Their hearts are fine. In adults, though, murmurs often mean there is some kind of problem with the heart. This is a good example of how different kids are from adults.

Evaluating a newly-heard murmur starts with asking about the history. Is there anything going on that possibly suggests a heart problem? For instance, has there been fainting or chest pain during exercise? Is there a family history of heart problems in young people? Murmurs are always more concerning in a child whose history is suspicious for possible heart disease.

The murmur itself needs to be listened to carefully, often while moving the child into different positions. Based on how it sounds, a pediatrician can tell how likely that particular noise is to indicate an actual heart problem. Since most murmurs in kids are normal, we don’t usually refer all of them to cardiologists or for testing (if we did, there wouldn’t be nearly enough cardiologists or EKG machines.) If I listen to a murmur and I’m confident it’s normal, I’ll tell that to the parents and I won’t refer. If I listen to a murmur and I think it might be an abnormal sound, or if I’m worried based on the history or other findings, I’ll refer the child for further evaluation.

Murmurs (especially normal murmurs that don’t mean anything) come and go. Doctors can hear them better when the heart beats stronger (for example, during a fever or when a child is excited). Murmurs may be missed if a child is upset or yelling during an exam. Though some are present from birth, it’s not unusual for a murmur to be first heard in a child at any age.

So: though most murmurs in children are normal, they do need to be evaluated carefully by considering the history and complete physical exam. Many can be easily distinguished at the pediatrician’s office as normal, without further testing. Others are kind of borderline, and may turn out to be normal—but need additional confirmation to prove that. If as a parent you’re uncomfortable without confirmation that a murmur is normal, speak up—don’t just worry silently. I never mind doing a referral for reassurance for myself, OR a parent.

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8 Comments on “Heart murmurs in children are usually nothing to worry about”

  1. Dr. Roy Says:

    Pasting a question posted via Facebook:

    Question for you, Dr Roy (solely based on curiosity): What is the AAP position on prophylactic antibiotics for dental cleaning in patients with heart murmurs? My husband was diagnosed with a murmur in his late teens, and his ped told his mother he needed the abx to try to prevent infection after his gums were poked and prodded. But this was *cough* years ago, so the position may have changed since then.

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  2. Dr. Roy Says:

    Very few murmurs need antibiotics for dental procedures– really, only those that are part of serious heart disease or from artificial valves. More: http://www.ada.org/sections/scienceAndResearch/pdfs/patient_75.pdf

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  3. Emile Ballard Says:

    From: surreyhill Sent: 12/11/2005 00:03 Trish, there are so many instances of Whippets who had a murmur heard one time by one vet, but whose murmur did not get heard a second time by a different vet, that I think every person who has a young or puppy Whippet diagnosed with a “murmur” should see a cardiac specialist OR wait a year and have the heart listened to by a vet who is truly used to hearing sighthound hearts before pushing the panic button. I think that this is why many breeders make light of low-grade murmurs in puppies. It may indeed be due to a transitory physical stage or to inexperience in listening to young sighthound hearts on the part of the Vet. Multiple diagnoses combined with an echo which shows backflow or regurgitation through the valve should be mandatory before one should think their Whippet has an actual pathological cardiac condition. Whippet ribcages and hearts ARE different.

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  4. Dr. Roy Says:

    Emile, you do know I’m talking about humans here, right?

    OTOH, our family dog growing up was a whippet. Great dog! So I’m approving this odd comment anyway.

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  5. Ani Says:

    Dr Roy, I really appreciate the article above. I just came back from a pediatrician’s office,checked my child out and said that she heard a faint murmur, and referred me to a pediatric cardiologist. Obviously I am freaking out now trying to get as much information as possible. When she meant ‘Faint” I saw that there is a grading systems for these murmurs.Are faint murmurs innocent murmurs???

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  6. Dr. Roy Says:

    There is a grading system for the “loudness” of murmurs, on a scale from 1 to 6 (6 is loudest– you could hear a six without a stethescope!). Almost all murmurs are 1 to 3. A “faint” murmur is probably a 1.

    In general, louder murmurs are more likely to be caused by a genuine problem, and softer (grade 1) murmurs are less likely to be a problem. But there are other qualities to murmurs, including the “character” of the sound, where in the heart cycle they’re heard, and other things that we listen for that help us make a determination if a murmur is likely to be problematic.

    It’s also certainly true that different doctors probably have their own comfort level– some are probably quicker to refer than others. That may reflect confidence, but is also a matter of practice style.

    I would say if your ped thought a cardiologist eval was a good idea, you should probably do it.

    Best of luck!

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  7. Ani Says:

    I really appreciate your response and a quick response doctors,While most doctors don’t have time to even check on their patients at office visits, you are taking time to write blogs(which are informative) and reply to emails from senders. There are not many out there like you doctor.

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  8. It’s interesting that you mentioned that about 50% of kids will have a murmur heard at least once during their childhood. My wife and I took our son to the pediatric cardiologist for this very reason, but he assured us that it was completely normal. Knowing that it’s common among children is more reassuring, and helps us have more confidence in our son’s health.

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