If your child has been referred for an echocardiogram, it is natural to have questions about what the scan involves and what it might show. A standard transthoracic echocardiogram, often called an echo, is a non-invasive ultrasound scan that creates moving images of your child’s heart without using ionising radiation.
The scan can assess the heart’s chambers, valves, pumping function and blood flow. It may be recommended to investigate a murmur or symptoms, assess a suspected structural difference or monitor an existing heart condition. Knowing what to expect can help you and your child feel more prepared before the appointment.
What Is an Echocardiogram?
An echocardiogram, often called an echo, is an ultrasound scan that uses high-frequency sound waves to create moving images of your child’s heart. A small handheld probe is placed on your child’s chest, allowing the clinical team to see the heart’s chambers, valves and blood flow in real time.
Unlike an ECG, which records your child’s heart’s electrical activity, an echocardiogram shows how the heart is structured and how well it is working. This helps the clinical team assess the heart’s pumping action, valve function and blood flow from different angles.
Why Might Your Child Need an Echocardiogram?
Your child may be referred for an echocardiogram if a doctor hears a heart murmur or if they have symptoms such as unexplained breathlessness, fainting, chest discomfort or reduced exercise tolerance. Your baby may also need the scan if they have feeding difficulties, rapid breathing, poor weight gain or findings during their newborn examination that need further assessment.
An echocardiogram may also be recommended when a close relative has a confirmed inherited heart condition or a specific congenital heart condition for which family screening has been advised. A family history of a heart murmur or congenital heart condition does not automatically mean that every child needs an echocardiogram; the decision depends on the relative’s diagnosis and the screening recommendations for that condition.
Not every child with a murmur, chest discomfort or fainting needs echocardiography. The decision should be based on the specific symptoms, cardiovascular examination, family diagnosis and whether imaging is likely to answer a relevant clinical question.
When Should You Seek Urgent Help Instead of Waiting for the Scan?
An echocardiogram is a planned investigation and should not delay emergency care. Call 999 if your child is not breathing, is unresponsive, has severe difficulty breathing or suddenly develops blue or grey lips, tongue, face or skin. On brown or black skin, this colour change may be easier to see on the lips, gums, inside the eyelids, palms of the hands or soles of the feet.
Call 999 if your child faints and cannot be woken within one minute, has not fully recovered, has difficulty speaking or moving, has been seriously injured, is shaking or jerking as if having a seizure, faints during exercise or while lying down, or faints with chest pain or a pounding, fluttering or irregular heartbeat.
For worsening breathlessness, poor feeding, poor weight gain, persistent palpitations or a significant reduction in exercise tolerance without emergency features, contact NHS 111, your GP or your child’s cardiology team. Tell the healthcare professional about the planned echocardiogram and any known heart condition.
How Does Doppler Echocardiography Assess Blood Flow?
Doppler echocardiography is usually performed as part of your child’s echocardiogram and helps the cardiologist assess the direction and speed of blood flow through the heart. Colour Doppler adds coloured images to the scan, making it easier to identify unusual blood flow through a heart valve, blood vessel or opening between the heart’s chambers.
During the scan, you may hear swishing or pulsing sounds, but these are simply electronic representations of your child’s blood flow and do not affect them in any way. Your child’s cardiologist will interpret these findings alongside the heart’s structure and overall assessment to build a complete picture of how the heart is working.
Which Heart Conditions Can Echocardiography Help Diagnose?
An echocardiogram can help diagnose many heart conditions by showing your child’s heart structure, valves, blood vessels and pumping function in detail. It is commonly used to identify congenital heart conditions, such as small openings between the heart chambers, valve abnormalities and narrowing of major blood vessels, as well as conditions affecting the heart muscle.
An echocardiogram may also assess acquired problems affecting the heart muscle, valves, fluid around the heart or pumping function. The exact findings must be interpreted with your child’s symptoms, examination and other investigations.
An echo does not record intermittent heart rhythms and cannot explain every episode of chest discomfort, palpitations, dizziness or fainting. An ECG, longer rhythm monitor, exercise test or another investigation may therefore be more appropriate for some symptoms.
Can an Echo Show Whether a Heart Murmur Is Innocent?
An echocardiogram can show whether the heart appears structurally normal or whether a structural condition is affecting blood flow. The clinician will interpret the scan alongside the murmur’s characteristics, your child’s symptoms and the rest of the cardiovascular examination.
A well, symptom-free child whose murmur has confidently innocent clinical features may not need echocardiography. Imaging or specialist assessment is more appropriate when the murmur cannot confidently be classified as innocent, symptoms are present, another cardiovascular finding is abnormal or there is a relevant family history.
Is Echocardiography Safe for Babies and Children?
Safety of Echocardiography in Children
| Aspect | What It Involves | Why It Matters | What Parents Should Know |
| No radiation exposure | Uses ultrasound waves to create images of the heart | Avoids exposure to X-rays or ionising radiation | Can be repeated without ionising-radiation exposure when clinically needed |
| Non-invasive procedure | Probe moves gently over the chest with ultrasound gel | No surgery or injections are usually required | Most children tolerate the scan well |
| Monitoring during scan | ECG stickers may be used to record the heartbeat | Helps the team relate the ultrasound images to the heartbeat | The stickers are usually removed gently after the scan |
| Child comfort | Cold gel and gentle pressure from the probe may feel unusual | Some children may find the experience uncomfortable | Comfort and reassurance can help |
| Keeping still | Young children may struggle to remain still during the scan | Movement can affect image quality | Staff may use distraction or extra support |
| Specialised echocardiograms | Some specialised examinations may use contrast, sedation or a different technique | These options may help answer a specific clinical question or obtain adequate images | The team will explain why the option is needed, along with any preparation, benefits and risks |
How Should You Prepare Your Child for the Scan?
For a routine echocardiogram, your child can usually eat, drink and take their usual medicines unless the appointment letter says otherwise. Dress your child in comfortable clothing that is easy to remove around the chest, and explain the scan in simple, reassuring language so they know what to expect.
Let your child know that the gel may feel cold and the probe may press gently against their chest, rather than saying they will not feel anything at all. If your child is young or anxious, practising lying still at home and bringing a favourite toy, book or comfort item can help make the appointment easier.
Clinical Tip
Young children may find it helpful to practise lying still on their back or side while watching a familiar video or listening to a story. Bring a favourite toy or comfort item, and tell the team in advance about sensory, communication, developmental or mobility needs so that reasonable adjustments can be planned.
What Happens During a Transthoracic Echocardiogram?
During a transthoracic echocardiogram, your child will usually lie on an examination couch, although babies or younger children may sometimes be scanned on your lap or in another safe position supported by the clinical team. Small ECG stickers may be placed on your child’s chest to monitor the heartbeat, while ultrasound gel and a handheld probe are used to create moving images of the heart.
The specialist will move the probe over different areas of your child’s chest and may ask them to change position or briefly hold their breath if they are old enough. Once the scan is finished, the gel is wiped away, your child can get dressed straight away, and there is usually no recovery time needed.
Will the Echocardiogram Hurt?
A routine echocardiogram is usually painless because the probe remains on the outside of your child’s chest and does not break the skin. The gel may feel cold or wet, and pressure from the probe may cause mild or brief discomfort, particularly when a clear image is needed from a sensitive area.
If your child feels uncomfortable or says an area is painful, let the specialist know so they can adjust the pressure or change the position of the probe where possible. Your reassurance, along with simple explanations and gentle distraction, can also help your child feel more relaxed during the scan.
How Long Does a Paediatric Echocardiogram Take?
A routine echocardiogram often takes approximately 30 to 40 minutes, although the exact duration varies. It depends on the clinical question, your child’s age, how easily they can remain still, the images required and the complexity of the heart anatomy.
Your total visit may be longer if your child also needs observations, an ECG or a consultation. Avoid making tightly timed arrangements afterwards and ask the clinic for its usual appointment duration if travel, school or work plans are affected.
What Happens If Your Child Cannot Keep Still?
Most children have an echocardiogram while awake, using reassurance, distraction and a comfortable position to help them remain still. If the required images cannot be obtained, the team may pause, try again, arrange another appointment or consider sedation after assessing your child’s age, health, developmental needs and the urgency of the scan.
When sedation is planned, the team will provide instructions about food, drinks, medicines, recovery and supervision at home. Follow only the fasting instructions provided for your child, and tell the team about recent illness, breathing problems, allergies and any previous difficulty with sedation or anaesthesia.
UK Guidance Note
NICE guidance recommends an individual assessment before sedation, including your child’s current health, medicines, allergies, previous experience of sedation or anaesthesia and ability to cope with the procedure. The team should also explain the preparation, monitoring and recovery arrangements for the planned technique.
Do not fast your child or stop, delay or change their medicines unless the hospital has provided specific instructions for the planned sedation (National Institute for Health and Care Excellence, 2010).
What Is a Transoesophageal Echocardiogram?
A transoesophageal echocardiogram, or TOE, uses a specialised ultrasound probe positioned in the oesophagus, which lies close behind the heart. It can provide detailed images when a standard transthoracic echocardiogram cannot show the required structures clearly and may also be used to guide selected cardiac procedures.
A TOE is not a routine outpatient echocardiogram and is usually performed under general anaesthetic in children. Once your child is asleep, the probe is carefully passed through the mouth into the oesophagus. The clinical team will explain the fasting instructions, consent process, anaesthetic, recovery arrangements and individual risks. These include a small risk of injury to the lips, teeth, tongue or oesophagus. Follow the hospital’s specific instructions rather than the preparation advice for a routine transthoracic scan.
When Will You Receive the Results?
The cardiologist may be able to discuss the main findings during the same appointment, particularly when they have reviewed or performed the scan. In other services, an echocardiographer completes the examination and sends a formal report to the referring consultant or GP for discussion later.
Before leaving, ask when the final result is expected and how it will be communicated. A longer examination does not necessarily mean that a problem has been found because scan time also depends on movement, image quality and the number of measurements required.
What Can an Echocardiogram Not Show?
An echocardiogram provides detailed information about your child’s heart, but it cannot diagnose every heart problem or explain every symptom. If your child has palpitations, dizziness or fainting, they may need an ECG or longer heart-rhythm monitoring. MRI or CT may be recommended when different or more detailed anatomical imaging is required, while cardiac catheterisation may be used when direct pressure measurements, detailed blood-flow information or catheter-based treatment is needed.
A normal echocardiogram does not rule out every cause of chest discomfort or breathlessness, as these symptoms can also be related to the lungs, muscles or other parts of the body. Your child’s cardiologist will always interpret the scan alongside their medical history, examination findings and any other relevant tests.
Will Your Child Need Follow-Up Echocardiography?
A single reassuring echocardiogram may be sufficient when the heart appears structurally normal and the wider clinical assessment identifies no continuing concern. However, a normal scan does not automatically explain every symptom, so the clinician may recommend an ECG, rhythm monitor or another investigation when appropriate.
If a heart condition is identified, follow-up echocardiograms may be used to monitor heart size and pumping function, valve performance, blood flow or the result of treatment. The interval between scans depends on the diagnosis and your child’s individual findings rather than on one standard timetable. Attend any planned follow-up appointments even when your child feels well.
Myth vs Fact
| Myth | Fact |
| An echocardiogram exposes your child to radiation. | A standard echo uses ultrasound sound waves rather than X-rays, so it does not expose your child to ionising radiation. |
| The scan sends electricity into your child’s heart. | The ultrasound probe sends and receives sound waves. ECG stickers may monitor the heartbeat, but they do not deliver electricity. |
| Every child having an echo needs sedation. | Most children have a standard echo while awake. Sedation may be considered when adequate images cannot otherwise be obtained and must be planned using an individual clinical assessment. |
| An echocardiogram is painful. | A routine transthoracic echo is usually painless, although the gel may feel cold and pressure from the probe can cause brief discomfort. |
| A longer scan means that the specialist has found a serious problem. | Scan time depends on the images required, your child’s movement, their anatomy and the complexity of the assessment. |
| An echocardiogram can identify every possible heart problem. | An echo provides detailed structural and functional information, but ECG monitoring, MRI, CT or other tests may be needed for some concerns. |
| Every heart murmur requires an echocardiogram. | A well child with a confidently identified innocent murmur may not require imaging. An echo is more likely when symptoms, abnormal examination findings or diagnostic uncertainty are present. |
Key Takeaways
- A standard echocardiogram uses ultrasound and does not expose your child to ionising radiation.
- The scan assesses heart structure, valves, pumping function and blood flow.
- Not every child with a murmur, chest discomfort or fainting needs an echocardiogram.
- A routine scan is usually painless, although cold gel and probe pressure may cause brief discomfort.
- Most children do not need sedation; follow the hospital’s individual preparation instructions when sedation is planned.
- An echo cannot identify every rhythm problem or cause of symptoms, so other tests may sometimes be required.
- Do not wait for a planned scan if your child is not breathing, becomes unresponsive, has severe breathing difficulty, suddenly develops blue or grey lips, tongue, face or skin, cannot be woken within one minute after fainting, faints during exercise or while lying down, or does not recover normally after fainting.
FAQs
1. What is an echocardiogram for a child?
An echocardiogram, or echo, is a non-invasive ultrasound scan that creates moving images of your child’s heart. It allows the clinical team to examine the heart’s structure, valves, pumping function and blood flow without using ionising radiation.
2. Why would my child need an echocardiogram?
An echocardiogram may be recommended to investigate a murmur with concerning features, assess symptoms or examination findings that suggest a structural heart problem, screen for a specific inherited condition or monitor an existing diagnosis. Not every child with chest discomfort, fainting or an innocent murmur needs a scan.
3. Is an echocardiogram painful for children?
A standard transthoracic echocardiogram is usually painless and does not normally involve a needle, injection or surgery. Your child may feel cold gel or brief discomfort from the pressure of the probe, so they should tell the specialist if an area feels painful.
4. Does an echocardiogram use radiation?
No. An echocardiogram uses ultrasound sound waves rather than X-rays, so your child is not exposed to ionising radiation. When follow-up imaging is clinically necessary, the scan can be repeated without radiation exposure. The timing and number of scans will depend on your child’s diagnosis.
5. How long does a child’s echocardiogram take?
Many routine paediatric echocardiograms take approximately 30 to 40 minutes, although the exact duration varies according to the images required, your child’s movement and the complexity of the assessment.
6. Does every child with a heart murmur need an echocardiogram?
No. A trained clinician may be able to identify an innocent heart murmur without an echocardiogram when the child is well, has no concerning symptoms and the rest of the cardiovascular examination is reassuring. Imaging or specialist assessment is more likely when symptoms, abnormal examination findings or diagnostic uncertainty are present.
7. Will my child need sedation for an echocardiogram?
Usually not. Most children have a standard echocardiogram while awake, with reassurance, distraction and a comfortable position helping them to remain still. Sedation may be considered when clinically adequate images cannot otherwise be obtained. The decision will depend on your child’s age, health, developmental and communication needs and the urgency of the scan.
8. Can parents stay with their child during the scan?
A parent or caregiver can usually remain with the child during a standard transthoracic echocardiogram. Local policies, space, infection-control requirements or a specialised procedure may occasionally affect this, so ask the clinical team if you are unsure.
9. When will we receive the echocardiogram results?
The timing varies between hospitals and clinics. Some families receive an explanation during the same appointment, while others receive the results after the images have been reviewed by a paediatric cardiologist.
10. What happens if the echocardiogram shows a heart problem?
If the scan identifies a heart condition, the cardiologist will explain what has been found, whether more tests are required and what happens next. Depending on the diagnosis, the plan may involve reassurance, monitoring, medicine, a catheter-based procedure or surgery; an abnormal finding does not automatically mean that immediate treatment is needed.
Final Thoughts: Understanding the Value of Echocardiography for Your Child
An echocardiogram provides detailed moving images of your child’s heart without using ionising radiation. It can help assess the heart’s structure, valves, pumping function and blood flow, but the findings must still be interpreted alongside your child’s symptoms, examination and any other relevant tests.
Knowing what will happen during the scan can help you prepare your child and understand why the examination has been recommended. If your child needs a heart scan, you can contact London Paediatric Clinic to arrange paediatric echocardiography in London and discuss the preparation, appointment process and how the results will be communicated.
References:
- Leeds Teaching Hospitals NHS Trust (2025) ‘Having an echocardiogram’. Available at: https://www.leedsth.nhs.uk/services/congenital-heart-unit/leeds-congenital-hearts-children-and-teenagers/having-an-echocardiogram/
- NHS (2026) ‘Echocardiogram’. Available at: https://www.nhs.uk/tests-and-treatments/echocardiogram/
- University Hospital Southampton NHS Foundation Trust (no date) ‘Diagnosis and treatment – children’s cardiac’. Available at: https://www.uhs.nhs.uk/for-visitors/southampton-childrens-hospital/childrens-services/childrens-cardiac/diagnosis-and-treatment
- Evelina London Children’s Hospital (no date) ‘Echocardiography’. Available at: https://www.evelinalondon.nhs.uk/our-services/hospital/heart-services/treatments/echocardiography.aspx
- Norfolk and Norwich University Hospitals NHS Foundation Trust (2024) ‘Cardiology Advice and Referral Pathways – Paediatrics’, CA4073 v7. Available at: https://www.nnuh.nhs.uk/publication/download/cardiology-advice-and-referral-pathways-paediatrics-ca4073-v7/
- Lopez, L. et al. (2024) ‘Guidelines for performing a comprehensive pediatric transthoracic echocardiogram: recommendations from the American Society of Echocardiography’, Journal of the American Society of Echocardiography, 37(2), pp. 119–170. Available at: https://pubmed.ncbi.nlm.nih.gov/38309834/
- National Institute for Health and Care Excellence (2010) ‘Sedation in under 19s: using sedation for diagnostic and therapeutic procedures’, CG112. Available at: https://www.nice.org.uk/guidance/cg112
- NHS (2023) ‘Fainting’. Available at: https://www.nhs.uk/symptoms/fainting/
- NHS (2023) ‘Blue or grey skin or lips (cyanosis)’. Available at: https://www.nhs.uk/symptoms/blue-skin-or-lips-cyanosis/
- Great Ormond Street Hospital for Children NHS Foundation Trust (2025) ‘Anaesthesia for cardiac catheterisation procedures’. Available at: https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/anaesthesia-for-cardiac-catheterisation-procedures/