What are some characteristics of children with functional heart conditions?
-
Children with heart conditions may only have problems intermittently or for a short period.
-
These children often have pediatric cardiologists helping with their management in addition to a primary care provider in the medical home.
-
The children seldom require other special therapists to be involved in their care, but the specifics of the child’s situation should be discussed with parents/guardians.
-
This Quick Reference Sheet will provide information on
-
Kawasaki disease
-
Arrhythmia
-
Hypertension (high blood pressure)
-
Cardiomyopathy
-
Kawasaki Disease
What is Kawasaki disease?
-
Kawasaki disease is a condition in which the blood vessels become inflamed, especially in the heart where the coronary arteries supply blood to the heart muscle.
-
Children with early Kawasaki disease usually have high fever, red eyes, and swollen hands and lips that become cracked as they heal.
-
They can also have a rash, swollen mouth and tongue, and swollen lymph nodes.
-
This disease is not well understood and its cause is unknown. It can be very tricky to diagnose because there is no test to specifically diagnose the disease.
-
Children are usually hospitalized when they have the acute disease, but some of the most serious complications can happen in the recovery stage during the month or two after the disease begins. At that time, the coronary arteries can get weak spots that balloon out and cause aneurysms.
-
Luckily, even though Kawasaki disease is not well understood, it can be treated. Many of the complications can be avoided with treatment and monitoring. Often, children make a complete recovery from Kawasaki disease.
How common is it?
Approximately 4,000 children are diagnosed with Kawasaki disease every year and most are younger than 5 years.
What adaptations may be needed?
Medications
-
Children recovering from Kawasaki disease may need to take low-dose aspirin for awhile until it is certain that they have recovered completely.
-
The aspirin may cause stomach irritation.
-
Parents/guardians should be notified immediately if there is blood when the child has a bowel movement or vomits.
-
Aspirin is given to prevent blood clots, so the child might bruise more easily or bleed more if cut.
-
-
Children recovering from Kawasaki disease should avoid children with chickenpox or the flu if they are on aspirin because of the risk of Reye syndrome, a serious illness that causes liver and brain dysfunction. All children should be vaccinated against chickenpox and influenza, but this is especially important for children who are on aspirin therapy.
-
Vaccination—the medication used to treat Kawasaki disease in the hospital, called gamma or immune globulin, can interfere with the effectiveness of live vaccines like measles, mumps, rubella (MMR), and varicella (chickenpox), and those vaccines may need to be delayed for a period. The children should have a note from their primary care provider and should be vaccinated by 1 year after administration of the immune globulin.
Dietary considerations
Usually no special diet is needed.
Physical environment
Most children with Kawasaki disease usually recover completely and need no special adaptations.
What should be considered an emergency?
Seldom a problem, but if the child has a complication, it may present as chest pain or paleness.
What are some resources?
-
American Heart Association,www.americanheart.org
-
Kawasaki Disease Foundation,www.kdfoundation.org, 978/356-2070
Arrhythmia
What is arrhythmia?
-
Arrhythmia is an irregular heartbeat. The heart normally sends a regular electrical signal that makes the heart muscle contract in a proper order. If that signal order is not working well, the heart can have an irregular beat.
-
This disorder may interfere with the heart’s ability to pump blood.
-
The feelings that it causes are called
heart palpitations; they can be difficult sensations for a child to describe. -
Many people have experienced minor palpitations that are usually not serious. They can be caused by stress or substances like caffeine or cold medications.
-
Some forms of arrhythmia are very serious and need immediate treatment. Some of the more serious types of arrhythmias can be caused by conditions such as prolonged QT interval, cardiomyopathy, or Wolf-Parkinson-White syndrome.
-
Children who have congenital heart disease may have arrhythmias.
-
Arrhythmias that occur in the top chambers of the heart are called
atrial, such as atrial fibrillation or flutter. -
Arrhythmias that occur in the bottom heart chambers are called ventricular, such as
ventricular tachycardia. -
These conditions may be treated with medication, surgical procedures on the heart’s electrical conduction system, or pacemakers.
What adaptations may be needed?
Medications
-
A number of different medications may be prescribed to prevent an irregular heartbeat. Ask the child’s parents/guardians and doctors to explain the medications and their side effects.
-
Avoid over-the-counter medications unless specifically approved by the child’s doctor.
Dietary considerations
Avoid caffeine-containing food or drinks such as coffee, tea, or chocolate unless approved by the child’s doctor.
Physical environment
-
Because there are many different types and causes of arrhythmia, it is important to customize the child’s Care Plan to match the specific situation.
-
Activity—usually unrestricted but the child should be allowed to rest if needed.
-
Some arrhythmias require restriction of certain athletic activities in schools.
What should be considered an emergency?
-
Symptoms like paleness, sweating, dizziness, fainting, chest pain, or shortness of breath may be serious.
-
Learn to monitor a pulse.
-
Call emergency medical services/911 immediately if the child is having serious symptoms.
What types of training or policies are advised?
-
Pediatric first aid training that includes CPR (management of a blocked airway and rescue breathing) with instructional demonstration and return demonstration by participants on a manikin.
Pediatric First Aid for Caregivers and Teachers is a course designed to teach these skills. -
If there is a child with an arrhythmia enrolled, it is important to have a responsible caregiver who can competently provide CPR on site at all times.
-
A CPR-trained person should be available during transport to and from the program if applicable.
Hypertension (High Blood Pressure)
What is hypertension (high blood pressure)?
-
Hypertension is much less common in children than adults.
-
High blood pressure in younger children usually has another cause such as a kidney problem or other medical condition.
-
Older children may develop
essential hypertension, which is high blood pressure without a known cause, especially if they have a strong family history.
What adaptations may be needed?
Medications
Avoid over-the-counter medications unless specifically approved by the child’s doctor.
Dietary considerations
-
Children with high blood pressure may be on a low-salt diet.
-
Children should avoid products that contain caffeine such as chocolate, tea, or coffee.
Physical environment
If a child in the child care center or school has hypertension, ask the parent/guardian to get information specific for that child.
Cardiomyopathy
What is cardiomyopathy?
-
Cardiomyopathy is the name for diseases of the heart muscle. It can have many different causes and different outcomes depending on the cause.
-
Children with cardiomyopathy are at increased risk for arrhythmias, heart failure, and sudden death.
How common is it?
There are about 1,000 to 5,000 new cases per year in the United States.
What adaptations may be needed?
Physical environment
Cardiomyopathy is relatively uncommon, but it is a condition that should be discussed at length with parents/guardians and the child’s doctor.
What types of training or policies are advised?
-
How to take a pulse
-
Emergency situations/CPR
What are some resources?
-
American Heart Association,www.americanheart.org
-
Congenital Heart Information Network,http://tchin.org, 609/822-1572
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.