Children and Heart Murmurs

by Tom Seman MD FAAP January 31st, 2013 | Pediatrician on Call
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babyMy child’s doctor mentioned the word murmur at our last visit.  What is that?

Over the millennia the heart has been revered and imagined as the center and master of the body and soul. In ancient Egypt, it was preserved with the mummy while the brain was removed and thrown away.  All of the great writers, from the ancient Greeks through Shakespeare to those of the twenty first century, center on the heart.  It is so strong, yet it breaks so easily.  The sound of it beating reminds us we are alive.

When a physician evaluates a child, one of the important parts of the exam is listening to the heart and all of its sounds. These are the sounds of blood flowing through the different chambers, and the major blood vessels entering and leaving the heart itself.  When doing so, the doctor will hear a murmur 30% of the time.

These murmurs may be persistent or intermittent, increasing or decreasing in intensity based on how fast the blood is flowing.  This is the same way you can hear the different sounds of water in a garden hose – how fast it’s flowing, if the hose is coiled or otherwise bent.  80% of the time these extra sounds are just that, sounds that mean nothing. They are referred to as innocent murmurs.  These can be persistent or intermittent occurring for a variety of reasons, such as exercise, anemia, fever, infection, or dehydration.  Most pediatricians can identify these innocent murmurs with no testing.

Over the years there has been a lot of studies to determine what physicians should do if they hear an innocent murmur: tell or not tell the parents.  Some studies demonstrated that if parents were informed, they still treated the child as if he or she was sickly.  Even with this evidence, it is still important for a parent to be made aware of a child’s benign murmur, since a new onset murmur during a time of illness can sometimes foreshadow something more ominous; therefore, a more advanced evaluation of the child is necessary.

Of the 20% of murmurs that are not benign or innocent, most are heard early in the child’s life, usually by the age of two.  These murmurs occur when there are structural changes in the heart.  The irregular current resulting can cause different sounds. Recent studies show that primary care physicians are not well versed in identifying the causes of murmurs, thus necessitating a referral to a Pediatric Cardiologist (heart specialist). These physicians will evaluate the child by using a variety of tests, including an ultrasound or Cardiac Echocardiogram and an MRI. Proper evaluation is paramount, as correction procedures may be needed.

During February, National Heart Month, listen to and keep your child close.  After all, the smile and laughter of a child can melt one’s heart.

Good luck,

Dr. Tom








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All health and medical information is provided for educational purposes and is not meant to replace the medical advice or treatment of your healthcare professional.