Being told that your child has a heart murmur can be worrying, but you should remember that a murmur is simply an extra sound heard when blood flows through the heart. Many heart murmurs in children are innocent and do not mean your child has a heart problem.
Not every child with a heart murmur needs an immediate paediatric cardiology referral. The next step depends on your child’s age, symptoms, examination findings, family history and whether a trained clinician can confidently identify an innocent murmur. Newborn babies and children with concerning symptoms or abnormal findings require more careful assessment.
What Is a Heart Murmur?
A heart murmur is an extra whooshing or swishing sound that a healthcare professional hears when listening to your child’s heart with a stethoscope. You cannot usually hear or feel the murmur yourself, and it is often discovered during a routine examination.
A heart murmur does not automatically mean your child has a heart problem. The healthcare professional will consider the sound, your child’s overall health, and any other findings before deciding whether you need further assessment or reassurance.
Why Are Heart Murmurs So Common in Children?
Heart murmurs are common in children because normal blood flow can sometimes be heard clearly through a stethoscope, particularly when the heart is beating faster. Many of these sounds are innocent and occur even when your child’s heart is completely healthy.
An innocent murmur can come and go depending on your child’s position, breathing, or activity level. If you are told that the murmur is present at one visit but not another, it does not necessarily mean that your child’s heart health has changed.
What Is an Innocent Heart Murmur?
An innocent heart murmur is an extra heart sound caused by normal blood flow through a healthy heart. You should know that it does not indicate heart disease and does not affect how well your child’s heart works.
Children with an innocent murmur are usually otherwise healthy and can grow, play and take part in normal activities. Although only a trained healthcare professional can confirm that a murmur is innocent, a confirmed innocent murmur is caused by normal blood flow and does not usually require treatment, cardiology follow-up or activity restrictions.
Does an Innocent Murmur Need a Cardiology Referral?
If an older child is well, has no concerning symptoms and a trained clinician is confident that the murmur is innocent, referral to a paediatric cardiologist may not be necessary. Referral is more likely when the child is a newborn or young infant, the murmur cannot confidently be classified as innocent, symptoms are present, the examination is abnormal or there is a concerning family history.
Once a murmur has been confirmed as innocent, ongoing cardiology appointments, heart tests or treatment are not usually needed. Follow the advice provided by your child’s clinician and request another assessment if new symptoms develop or their health or exercise tolerance changes.
When Is Reassurance Usually Appropriate?
Reassurance may be appropriate when your child is healthy, has no concerning symptoms, is growing and developing as expected and a trained clinician identifies features of an innocent murmur. Normal pulses and oxygen saturation are reassuring findings, but they do not by themselves confirm that a murmur is innocent.
Only a trained healthcare professional can decide whether a murmur has the features of an innocent heart murmur. If there is any uncertainty or your child’s examination raises concerns, you may be referred to a paediatric cardiologist for further assessment.
Why May a Murmur Sound Louder During a Fever?
A fever can make your child’s heart beat faster, causing blood to flow more quickly and making an innocent heart murmur easier to hear. You may also notice this after exercise or when your child is anxious or excited.
As your child recovers and their heart rate returns to normal, the murmur may become quieter or disappear. However, you should not assume that a murmur heard during a fever is innocent, as a healthcare professional must still consider its characteristics and decide whether further assessment is needed.
Which Symptoms Make a Referral More Important?
Symptoms do not necessarily mean that your child has heart disease, but they make prompt medical assessment more important. These include poor feeding, sweating or breathlessness during feeds, poor weight gain, unexplained breathlessness, reduced exercise tolerance, palpitations, chest pain during exercise and fainting, particularly during physical activity.
You can help the clinician by describing exactly when the symptoms occur, how long they last, and how your child recovers afterwards. This information helps determine whether your child needs an urgent specialist assessment or further heart tests.
What Colour Changes Should You Look For?
Blue or grey colour changes affecting your child’s lips, tongue, face or skin may indicate low oxygen levels or another serious medical problem. On brown or black skin, the change may be easier to see on the lips, gums, palms, soles of the feet or inside the eyelids.
If your child suddenly turns blue or grey, especially if they have trouble breathing or become unusually sleepy or unresponsive, you should call 999 immediately. If the colour change is less sudden but still concerns you, seek urgent medical advice and mention that your child has previously been found to have a heart murmur.
UK Guidance Note
NHS guidance advises calling 999 if your child’s lips, tongue, face or skin suddenly turn blue or grey. They may also have difficulty breathing, chest pain, confusion, drowsiness or dizziness, or appear limp, floppy or unresponsive. Call 999 after fainting if your child is not breathing, cannot be woken within one minute, has not fully recovered, has difficulty speaking or moving, has chest pain or a pounding, fluttering or irregular heartbeat, has seriously injured themselves, has seizure-like shaking or jerking, or fainted during exercise or while lying down.
Why Are Feeding and Growth Important in Babies?
Feeding is hard work for a baby, so changes in feeding can sometimes be an early sign that your baby’s heart is working harder than it should. You should seek medical advice if your baby becomes breathless, sweaty, or unusually tired during feeds, or struggles to finish them.
Poor feeding can lead to slow weight gain, which may require further assessment if a heart murmur is also present. However, you should remember that feeding difficulties can have many causes, so your baby will need a full medical assessment to identify the underlying reason.
Why Are Newborn Murmurs Treated Differently?
Newborn heart murmurs should always be assessed promptly because signs of heart disease can be difficult to detect in the first few days of life.
- Early assessment: Identifies serious heart conditions before symptoms become more obvious.
- Normal circulation: Many murmurs result from normal changes in blood flow after birth.
- Physical examination: Doctors check oxygen levels, pulses, feeding, breathing and skin colour.
- Further testing: Some babies may need an echocardiogram, observation or follow-up review.
Most newborn murmurs are harmless, but early assessment ensures babies with heart conditions receive the right care without delay.
Does a Normal Pregnancy Scan Rule Out Heart Disease?
The routine 20-week screening scan looks for signs of serious cardiac abnormalities, but it cannot detect every congenital heart condition. Some differences may not be visible during the scan, while others may only become apparent after birth as your baby’s circulation changes.
If your baby has a heart murmur after birth, they will still need an assessment based on their symptoms and examination findings. A murmur does not automatically mean that a heart condition was missed during pregnancy, as many newborn murmurs are temporary or caused by normal blood flow.
Which Murmur Characteristics May Cause Concern?
Clinicians consider the timing, loudness, quality and location of the murmur and whether it spreads to another part of the chest, back or neck. Features that may require further assessment include a diastolic murmur, a continuous murmur that cannot be suppressed, a loud or harsh murmur, a palpable vibration known as a thrill, unusual heart sounds or a murmur that radiates to the back or neck.
The clinician will also check your child’s pulses, oxygen saturation, growth and general cardiovascular examination. These features require professional interpretation, so you should not use online descriptions or recordings to decide whether your child’s murmur is innocent.
How Does Family History Affect the Decision?
Your child’s family history can help the clinician decide whether a specialist heart assessment is needed, even if they seem healthy. You should mention any relatives with inherited heart conditions, congenital heart disease, or unexplained sudden deaths at a young age.
A family history does not mean your child will develop the same condition, but it helps guide the next steps. Based on this information, you may be offered further tests or a referral to a paediatric cardiologist if appropriate.
Clinical Tip
Before the appointment, note when the murmur was first detected and whether your child has experienced breathlessness, fainting, palpitations, feeding difficulties or reduced exercise tolerance. Bring details of medicines and relevant family history, particularly congenital heart disease, inherited rhythm conditions, cardiomyopathy or an unexplained sudden death at a young age.
What Happens During a Paediatric Cardiology Assessment?
The paediatric cardiologist will ask about your child’s symptoms, medical history, growth, and family history before carrying out a thorough examination. You may also be asked when the murmur was first noticed and whether your child has experienced any feeding, breathing, or exercise-related problems.
Depending on the findings, your child may have an ECG to assess the heart’s electrical activity and rhythm or an echocardiogram to examine its structure, valve movement, pumping function and blood flow. Not every child needs both tests. The results help the cardiologist decide whether your child needs treatment, follow-up or reassurance.
Does Every Child With a Murmur Need an Echocardiogram?
An echocardiogram provides detailed images of your child’s heart and may be recommended when a structural problem is suspected. You should know that not every heart murmur requires a scan, especially when a trained clinician can confidently identify it as innocent.
If your child has symptoms, abnormal murmur features, or the doctor is unsure about the findings, an echocardiogram may be needed. The cardiologist will explain why the test is recommended and how the results will help guide your child’s care.
Evidence Note: Not Every Murmur Requires a Scan
Clinical assessment remains central when a heart murmur is found. UK referral guidance states that routine ECGs and chest X-rays do not significantly contribute to distinguishing an innocent murmur from structural heart disease in an otherwise well, asymptomatic child. An echocardiogram is not required when a trained clinician confidently identifies an innocent murmur, but referral or imaging may be appropriate when symptoms, concerning murmur features, abnormal examination findings or diagnostic uncertainty are present (Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023; Ford, Lara and Park, 2022).
Can Your Child Exercise With an Innocent Murmur?
A confirmed innocent murmur usually does not stop your child from taking part in exercise, sports, school activities, or daily routines. You can allow your child to stay active because the murmur itself does not damage a healthy heart.
Follow any specific advice provided by your healthcare professional if the murmur has not yet been fully assessed or your child develops symptoms during activity. Stop the activity and seek medical advice if your child experiences chest pain, unusual breathlessness, palpitations or dizziness. Call 999 if your child faints during exercise, cannot be woken within one minute, has not fully recovered, has difficulty speaking or moving, has seizure-like shaking or jerking, has seriously injured themselves or suddenly develops blue or grey lips, tongue, face or skin.
Will an Innocent Murmur Need Treatment or Follow-Up?
A confirmed innocent murmur does not require treatment, medicine or surgery because it is caused by normal blood flow through your child’s heart. You can usually feel reassured that it does not affect your child’s health, growth, or daily activities.
Many innocent murmurs become quieter or disappear as your child grows, although some may remain for longer without causing problems. You should seek a new medical assessment if your child develops symptoms such as fainting, breathlessness, poor growth, or changes in exercise ability.
Myth vs Fact
| Myth | Fact |
| Every heart murmur means that a child has heart disease. | A murmur is an additional sound rather than a diagnosis. Many childhood murmurs are caused by normal blood flow through a healthy heart. |
| Every child with a murmur needs an urgent echocardiogram. | The need for a scan depends on symptoms, examination findings, the nature of the murmur and local referral guidance. |
| A loud murmur always means that the heart condition is severe. | The loudness of a murmur does not always reflect the seriousness of an underlying condition. The complete examination and any required tests are more informative. |
| An innocent murmur prevents a child from playing sport. | Once a murmur has been confirmed as innocent, children do not normally need exercise or activity restrictions. |
| A normal pregnancy scan rules out every congenital heart condition. | Antenatal scans detect many important conditions, but they cannot identify every possible heart difference. |
| Once a murmur has been confirmed as innocent, new symptoms can be ignored. | A confirmed innocent murmur is not caused by structural heart disease, but new symptoms such as fainting, breathlessness or reduced exercise tolerance still require medical assessment. |
Key Takeaways
- Many childhood heart murmurs are innocent and occur in otherwise healthy hearts.
- Not every older child with a confidently identified innocent murmur needs a paediatric cardiology referral.
- Newborn murmurs require prompt paediatric assessment because signs of a heart condition may initially be subtle.
- Symptoms such as poor feeding, poor growth, breathlessness, fainting or reduced exercise tolerance make further assessment more important.
- Not every murmur requires an echocardiogram; the decision depends on the complete clinical assessment.
- A confirmed innocent murmur does not normally require medicine, surgery, follow-up or activity restrictions.
- Call 999 if your child suddenly develops blue or grey lips, tongue, face or skin, has severe breathing difficulty, is not responding normally, does not fully recover after fainting, or faints during exercise or while lying down.
Frequently Asked Questions
1. Does every child with a heart murmur need to see a paediatric cardiologist?
Not every older child with a confidently identified innocent murmur needs specialist referral. However, newborn babies and children with symptoms, abnormal examination findings, a concerning family history or a murmur that cannot confidently be classified as innocent should receive further assessment according to the local referral pathway.
2. Does a heart murmur mean my child has heart disease?
No. A heart murmur is simply an extra sound caused by blood flowing through the heart. Many children have innocent murmurs, which occur in healthy hearts and do not affect their growth, activity levels or long-term health.
3. How can a doctor tell if a heart murmur is innocent?
A healthcare professional will listen to the murmur and consider factors such as your child’s symptoms, age, pulse, oxygen levels and overall examination. If there is any uncertainty, your child may be referred to a paediatric cardiologist for further assessment.
4. What symptoms with a heart murmur should I be concerned about?
Seek medical advice if your child has fainting, unexplained breathlessness, chest discomfort during exercise, palpitations, poor feeding, sweating during feeds, slow weight gain or reduced exercise tolerance. Call 999 if your child is not breathing, cannot be woken within one minute after fainting, has not fully recovered, has difficulty speaking or moving, faints during exercise or while lying down, or faints with chest pain or a pounding, fluttering or irregular heartbeat. Emergency help is also needed if they have seizure-like shaking or jerking, have seriously injured themselves or suddenly develop blue or grey lips, tongue, face or skin.
5. Does my child need an echocardiogram if they have a heart murmur?
Not always. An echocardiogram is recommended when the cardiologist needs to look more closely at the heart’s structure or when the murmur has features that require further investigation. Many innocent murmurs can be diagnosed without a scan.
6. Can my child play sports if they have a heart murmur?
If the murmur has been confirmed as innocent, your child can usually take part in normal activities, including sports and exercise. However, you should follow medical advice if your child has symptoms during activity or the murmur has not yet been fully assessed.
7. Are heart murmurs common in newborn babies?
Heart murmurs can occur during the newborn period, and many do not lead to a serious diagnosis. However, a newborn murmur requires prompt paediatric assessment because signs of an underlying heart condition may initially be subtle. The assessment may include oxygen-saturation measurements, pulse checks and a review of feeding, breathing and colour.
8. Can a normal pregnancy scan rule out all heart problems in my baby?
No. A routine pregnancy scan can detect many heart conditions, but it cannot identify every possible heart difference. Some conditions only become noticeable after birth as your baby’s circulation changes.
9. Will an innocent heart murmur go away as my child grows?
Many innocent murmurs become quieter or disappear as children grow, although some may remain for longer without causing any problems. They do not require medication, surgery or activity restrictions.
10. What happens during a paediatric cardiology appointment for a heart murmur?
The paediatric cardiologist will discuss your child’s symptoms, medical history and family history before examining their heart. If needed, your child may have tests such as an ECG or echocardiogram to help determine whether the murmur has innocent characteristics or may be associated with an underlying heart condition.
Final Thoughts: Understanding When Your Child’s Heart Murmur Needs Specialist Assessment
Being told that your child has a heart murmur can feel worrying, but many childhood murmurs are innocent and are not caused by structural heart disease. Whether specialist assessment is needed depends on your child’s age, symptoms, family history, the murmur’s clinical characteristics and the rest of the examination. Once a murmur has been confidently confirmed as innocent, treatment, cardiology follow-up and activity restrictions are not normally required.
If your child needs further assessment, you can contact London Paediatric Clinic to arrange a consultation with a paediatric cardiologist in London and discuss what the murmur may mean for your child’s care.
References:
- Norfolk and Norwich University Hospitals NHS Foundation Trust (2023) ‘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/
- Leeds Teaching Hospitals NHS Trust (2025) Heart murmur in newborn babies – What it means, what to look out for and what happens next. Available at: https://www.leedsth.nhs.uk/patients/resources/heart-murmur-in-newborn-babies-2/
- NHS (2025) Congenital heart disease. Available at: https://www.nhs.uk/conditions/congenital-heart-disease/
- NHS (2023) Blue or grey skin or lips (cyanosis). Available at: https://www.nhs.uk/symptoms/blue-skin-or-lips-cyanosis/
- NHS (2024) 20-week screening scan. Available at: https://www.nhs.uk/pregnancy/your-pregnancy-care/20-week-scan/
- NHS (2026) Echocardiogram. Available at: https://www.nhs.uk/tests-and-treatments/echocardiogram/
- Ford, B., Lara, S. and Park, J. (2022) Heart murmurs in children: evaluation and management. American Family Physician, 105(3), pp. 250–261. Available at: https://pubmed.ncbi.nlm.nih.gov/35289571/
- NHS (2023) Fainting. Available at: https://www.nhs.uk/symptoms/fainting/