What are signs of child heart problems

By Dr. Donya Betancourt

SANUR, Bali (JP): Usually the first sign or symptom of a congenital heart problem is the presence of a heart murmur (an abnormal vibration sound of the heart), which is detected with the help of a stethoscope.

Approximately 50 percent of newborns with congenital heart disease have abnormalities that are severe enough to require medical or surgical treatment within the first year of life. Symptoms are usually an increased rate of breathing, breathing difficulties resulting from lung congestion, shortness of breath when feeding (or trouble sucking), sweating while eating, poor appetite and an inability to gain weight.

Cyanosis occurs when a baby appears blue because of an inadequate supply of oxygen to the body. Discoloration may be particularly noticeable around the tongue and the inside of the mouth. If you suspect that your child has congenital heart disease, take your child to see the doctor immediately, for the sooner you get help, the better the chances are that your child will experience a full recovery.

When you take your child to the doctor, you will be required to present details of the family's medical history and a physical examination. The doctor can often make a diagnosis, if a particular murmur is a sign of heart disease, with a stethoscope alone. In some cases the doctor may perform tests such as a chest X-ray, using an electrocardiogram (ECG) or echocardiogram (heart ultrasound) to help diagnose the exact cause. Or the doctor may transfer your child to a pediatric cardiologist to decide on appropriate treatment options.

There are four options for treatment.

1. Clinical follow-up by a pediatric cardiologist in case of a minor defect such as a small ventricular septal defect (VSD) or an atrial septal defect (ASD), which can close in time. There is no need for medication, only the need to be careful about infection when undergoing dental treatment, in which case the doctor will prescribe antibiotic prophylaxis for bacterial infection.

2. Medication is used in moderately severe cases, usually to help the heart perform optimally while waiting for an operation.

3. Surgery is divided into partial treatment (to relieve symptoms and to wait until the child is healthy enough to undergo an operation) and corrective surgery to correct the defect.

4. Catheterization is a new technique that allows an ASD or VSD to be repaired without opening the chest. A small tube is passed through a vein in the leg and guided into the heart. A closure device "plug" is then delivered through the catheter to the defect which closes the hole.

Unfortunately not all defects are easily treated. Most congenital heart defects can be treated but not all can be cured.

What should parents do? The same as if you had a normal child: feed your child healthy food, be aware of not feeding them salty foods, limit exercise to as little as possible if the child shows signs of exhaustion. Immunization is important, as are regular dental checkups.

We know the cause of most defects (more than 90 percent) cannot be identified and less than 10 percent of the causes we know can be prevented or detected early on, such as rubella infection during pregnancy and abnormal chromosomes (Down's syndrome).

Rubella is a viral infection causing fever, cold symptoms and a rash that can be prevented by immunization at least three months before pregnancy. If you have any rash during pregnancy go and see the doctor immediately to find out if it is rubella.

Chromosome abnormality may happen in mothers who are older than 35 years, and today obstetricians do chromosome checkups when the mother reaches the second trimester. Avoid taking any medication without a doctor's prescription. At around 16 weeks to 18 weeks of pregnancy, the doctor can perform an ultrasound test to check the fetus' heart and rule out any deformity.

Stay informed and ask questions when you don't understand your doctor's advice. The chances of your child having a full and healthy life are promising.

The writer is a pediatrician based in Sanur, Bali. Questions? Contact Dr. Donya at drdonya@hotmail.com, or you can reach her at features@thejakartapost.com.