When your child is referred for an echocardiogram, it is understandable to have questions about radiation, discomfort and possible risks. A standard transthoracic echocardiogram is a non-invasive ultrasound scan that does not use X-rays or expose your child to ionising radiation.
During a standard transthoracic echocardiogram, a small handheld probe is moved over your child’s chest to create moving images of the heart. The scan normally involves no needles, injections or surgery and allows the clinical team to assess the heart’s chambers, valves, pumping function and blood flow.
After a routine awake scan, most children can return to their usual activities immediately. Different recovery advice applies when sedation, general anaesthesia, contrast or a specialised echocardiogram has been used.
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 or persistent palpitations without emergency features, contact NHS 111, your GP or your child’s cardiology team.
Why Is a Standard Echocardiogram Considered Safe?
A standard transthoracic echocardiogram uses a probe placed on the outside of your child’s chest. It does not normally involve surgery, needles or instruments entering the body, and it does not expose your child to ionising radiation.
Current evidence has not shown harm to patients from diagnostic ultrasound during regular medical use when it is used prudently by appropriately trained professionals for a clear clinical purpose (Society of Radiographers and British Medical Ultrasound Society, 2025).
Your child can usually return to normal activities straight after the scan, including eating, drinking, going to school or playing as usual. Echocardiograms can also be repeated when needed to monitor heart conditions as your child grows, with the decision based on whether the test will provide useful information.
Does an Echocardiogram Use Radiation?
A standard echocardiogram does not use X-rays or ionising radiation. Instead, it uses ultrasound sound waves to create images of your child’s heart, making it different from tests such as chest X-rays or CT scans that involve radiation.
Routine echocardiograms can be repeated when clinically necessary without creating a cumulative ionising-radiation dose. Each scan should still have a clear clinical purpose, such as monitoring heart function, valves, blood flow or a diagnosed structural condition.
If another investigation involving radiation is recommended, such as certain X-ray or CT examinations, the clinical team will explain why it is needed and how its expected benefit is balanced against the exposure involved.
How Do Ultrasound Waves Create Heart Images?
An echocardiogram creates images of your child’s heart using ultrasound waves from a small probe placed on their chest. These sound waves travel through the body, bounce back from different heart structures and are converted by the machine into moving images that allow the cardiology team to see the heart working in real time.
During Doppler assessment, the machine may produce swishing or pulsing sounds that represent information about your child’s blood flow. These are generated electronically from the returning ultrasound signals; they are not the actual sound of the blood and do not indicate that electricity is entering your child’s body.
Doppler echocardiography uses the reflected ultrasound signals to help assess the direction and speed of blood flow through the heart, valves and nearby blood vessels.
Does the Scan Send Electricity Into Your Child?
An echocardiogram does not send electricity into your child’s body or heart. The probe only uses ultrasound waves to create images, while any small sticky electrodes placed on your child’s chest simply detect the heart’s natural electrical activity and do not deliver any current.
The wires and stickers may look unfamiliar, but they are only used to help the machine match the images with your child’s heartbeat. If your child has sensitive skin, an adhesive allergy or a skin condition, let the team know so they can take extra care when placing or removing the stickers.
Will an Echocardiogram Hurt?
A standard echocardiogram is usually painless because the probe remains on the outside of your child’s chest and does not break the skin. Your child may notice cold or sticky gel and pressure from the probe, which can occasionally feel uncomfortable when the specialist needs a particular view.
Encourage your child to tell the echocardiographer if an area feels painful or the pressure becomes difficult to tolerate. The specialist may be able to adjust the probe, change your child’s position or pause briefly while still obtaining the required images.
Is the Ultrasound Gel Safe?
The ultrasound gel used during an echocardiogram is generally safe and helps the probe create clear images by improving contact with your child’s skin. It stays on the outside of the body, does not enter the heart or bloodstream and is simply wiped away once the scan is finished.
Your child may notice that the gel feels cool, wet or slightly sticky during the examination. Tell the echocardiographer if your child has broken or irritated skin, a dressing, eczema or another skin condition, or has previously reacted to ultrasound gel or medical adhesives. The team can then take appropriate precautions with the gel and any ECG stickers used during the examination.
Is Echocardiography Safe for Babies and Older Children?
Echocardiography Safety Across Different Ages
| Age Group | What Happens During the Scan | Comfort and Support | Important Points |
| Newborn babies | Ultrasound images are taken while assessing heart structure and function | You may be able to hold or comfort your baby during the scan | Crying or movement may make images and measurements harder to obtain but does not make a routine scan unsafe |
| Young infants | The scan may be performed while your baby is naturally asleep | Bringing milk, nappies, spare clothes and comfort items can help | No injections or anaesthesia are usually needed |
| Older children | The child may need to lie still or change positions during the scan | The team can explain each step and provide reassurance | Helps obtain clear images of the heart |
| Teenagers | The examination is adapted to their age and medical needs | Privacy and dignity are respected throughout | Staff explain procedures before starting |
| Routine awake scans | Uses ultrasound gel and a probe on the chest | Most children can return to normal activities afterwards | No recovery time is usually needed |
| Specialised scans | May involve sedation, anaesthesia or additional techniques if required | The cardiology team will discuss this beforehand | Only used when needed for specific clinical reasons |
How Should You Prepare Your Child?
A routine echocardiogram usually needs very little preparation, and your child can normally eat, drink and take their usual medicines unless you have been given different instructions. Dress your child in comfortable clothing that is easy to remove or open around the chest, and explain the scan in simple words that match their age.
You can tell your child that a small amount of gel will be placed on their chest and a probe will move over their skin to take pictures of their heart. Practising lying still, bringing a favourite toy, book or tablet and offering reassurance can help your child feel more relaxed during the appointment.
Clinical Tip
Contact the clinic before the appointment if your child has sensory, developmental, communication or mobility needs, significant anxiety, sensitive skin or a previous difficult experience with medical procedures. This gives the team time to plan appropriate explanations, positioning, distraction or other reasonable adjustments.
What Happens During the Examination?
During an echocardiogram, your child will usually need to remove or loosen clothing from their upper body and lie on an examination couch. The echocardiographer will apply gel to the chest and move the probe across different areas to capture images of the heart from several angles.
Your child may be asked to change position or briefly hold their breath if they are old enough, while younger children are encouraged to stay as calm and still as possible. Many routine scans take approximately 30 to 40 minutes, although a detailed or sedated examination may take longer. The duration depends on the views and measurements required, your child’s movement and the complexity of the assessment.
Can You Stay With Your Child?
A parent or caregiver can usually remain with the child during a routine transthoracic echocardiogram and help with reassurance or distraction. Local policies, room capacity, infection-control requirements or a specialised procedure may occasionally affect this, so ask the team if you are unsure.
Try to stay calm and reassuring, as children often pick up on your tone and body language. The person performing the scan may not always be able to explain the results immediately, as the images may need to be reviewed by a paediatric cardiologist before the findings are discussed with you.
What Happens If Your Child Moves or Cries?
If your child moves or cries during an echocardiogram, it does not make the scan unsafe. It may only make it harder for the echocardiographer to capture clear images, and the team can pause to help your child settle with a cuddle, feed or short break.
Paediatric teams are used to working with children who feel nervous or uncomfortable during medical appointments, so you do not need to feel embarrassed. If a complete scan cannot be obtained, the team will decide whether another appointment or, in some cases, sedation is needed based on how important the missing information is.
Does Every Child Need Sedation?
Most children complete a standard echocardiogram while awake, using preparation, reassurance, distraction and a comfortable position to help them remain still. Sedation may be considered when adequate images cannot otherwise be obtained because of age, anxiety, medical needs or developmental, communication or sensory difficulties.
When sedation is planned, the team will provide individual instructions about food, drinks, medicines, arrival time and recovery. Do not fast your child or stop a medicine unless the hospital has specifically instructed you to do so for the planned sedation technique.
Are There Risks From Sedation?
Sedation does not change how the ultrasound scan works, but sedative medicines introduce separate risks and recovery requirements. Depending on the medicine and level of sedation, possible effects may include prolonged sleepiness, irritability, nausea, vomiting or changes in breathing.
Before sedation, the team should assess your child’s health, medicines, allergies, breathing, recent illnesses and previous experiences with sedation or anaesthesia. Your child must be monitored during and after the procedure and should only leave once the agreed recovery and discharge criteria have been met.
UK Guidance Note:
NICE guidance requires an individual assessment before sedation and appropriate preparation, monitoring and recovery arrangements delivered by trained staff. Food and drink instructions depend on the sedation technique being planned.
Follow the instructions supplied specifically for your child rather than using general online fasting times. Contact the clinical team if your child becomes unwell before the appointment, and follow the supervision and emergency advice provided after discharge (National Institute for Health and Care Excellence, 2010).
What Additional Risks Apply to Specialised Echocardiography?
Most children have a routine transthoracic echocardiogram, in which the probe remains outside the chest. This does not use ionising radiation and normally requires no injection, sedation or anaesthetic.
Specialised techniques have additional considerations. A contrast echocardiogram may require a cannula and an injected contrast agent, and the clinical team should explain any observation or reaction advice that applies to the product being used.
A transoesophageal echocardiogram uses a probe passed into the oesophagus and is usually performed under general anaesthetic in children. Its additional risks relate to the probe, anaesthetic and procedure rather than to the ultrasound waves themselves.
Can Your Child Have Repeated Echocardiograms Safely?
A standard echocardiogram can be repeated when it is clinically necessary because it does not produce an accumulated ionising-radiation dose. Repeat scans may be used to monitor heart size and function, valves, blood flow or the outcome of treatment as your child grows.
Follow-up echocardiograms should still be requested for a clear clinical reason and performed using appropriate ultrasound settings. Having planned repeat scans does not automatically mean that the condition is worsening; they may be used to confirm that it remains stable.
What Should You Ask Before the Appointment?
Before your child’s appointment, ask whether they are having a routine awake echocardiogram or if sedation, anaesthesia or contrast is planned. You should also check whether your child can eat, drink and take their usual medicines, as preparation instructions may vary depending on the type of scan.
It can be helpful to ask how long the appointment may take, whether other tests are planned and when you can expect the results. Tell the team about any medical, developmental, sensory or communication needs so they can provide the right support and help make the examination as comfortable as possible.
Myth vs Fact
| Myth | Fact |
| An echocardiogram exposes your child to X-rays. | A standard echocardiogram uses ultrasound sound waves and does not involve ionising radiation. |
| The scan sends electricity into your child’s heart. | The probe sends and receives ultrasound waves. Any monitoring stickers only detect the heart’s natural electrical signals. |
| Every child needs sedation for an echocardiogram. | Most children have the scan while awake. Sedation may be considered when adequate images cannot otherwise be obtained and requires individual preparation, monitoring and recovery advice. |
| The ultrasound probe goes inside your child’s chest. | During a routine transthoracic echo, the probe remains on the outside of the chest and does not break the skin. |
| A longer scan means that something serious has been found. | Scan time can be affected by movement, anatomy and the number of images or measurements required. |
| Repeated echocardiograms expose your child to a cumulative radiation dose. | Routine echoes do not use ionising radiation, so repeated scans do not create a cumulative X-ray dose. They should still be performed for a clear clinical reason. |
| A sedated echo carries exactly the same risks as an awake echo. | Sedation does not change the ultrasound exposure, but sedative medicines have separate possible side effects and require additional preparation, monitoring and recovery advice. |
| Every type of echocardiogram is completely non-invasive. | A routine transthoracic echo is non-invasive, but specialised tests such as a transoesophageal echo involve a probe in the oesophagus and usually require anaesthesia in children. |
Key Takeaways
- A standard transthoracic echocardiogram uses ultrasound and does not expose your child to ionising radiation.
- The scan is usually painless, although cold gel and probe pressure may cause brief discomfort.
- Most babies and children complete the scan while awake without sedation.
- Sedation, contrast and transoesophageal echocardiography introduce separate preparation, monitoring and recovery considerations.
- Routine echocardiograms can be repeated when clinically necessary without building up an X-ray dose.
- Follow the clinic’s individual instructions and tell the team about medical, sensory, developmental or communication needs before the appointment.
- Do not wait for a planned echocardiogram 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. Is an echocardiogram safe for babies and children?
Yes. A standard transthoracic echocardiogram is a non-invasive test that uses ultrasound rather than ionising radiation. Diagnostic ultrasound has not been shown to cause harm when it is medically justified and performed appropriately by trained professionals. Your child may experience brief discomfort from cold gel or pressure from the probe, but the scan does not normally involve needles, injections or surgery.
2. Does an echocardiogram use X-rays or radiation?
No. An echocardiogram does not use X-rays or ionising radiation. It uses ultrasound to create moving images of your child’s heart, so repeat scans do not build up a cumulative X-ray dose. Each examination should still be performed for a clear clinical reason.
3. Is an echocardiogram painful?
A routine transthoracic echocardiogram is usually painless and normally involves no needle, injection or surgery. Your child may notice cold gel or brief discomfort from pressure on the chest, and they should tell the specialist if an area feels painful.
4. Can I stay with my child during the echocardiogram?
A parent or caregiver can usually remain with the child during a routine transthoracic echo. Local policies or a specialised procedure may occasionally affect this, so check with the team when the appointment is arranged.
5. Does every child need sedation for an echocardiogram?
No. Most children have an echocardiogram while awake. Sedation is only considered if a child cannot stay still long enough to obtain the medically necessary images.
6. How should I prepare my child for an echocardiogram?
For a routine echocardiogram, your child can usually eat, drink and take their usual medicines unless the appointment letter or clinical team provides different instructions. Dress them in comfortable clothing and explain that the scan involves placing cool gel on the chest and moving a small probe over the skin.
7. Are repeated echocardiograms safe?
Standard echocardiograms can be repeated when clinically necessary without accumulating an ionising-radiation dose. Follow-up scans may monitor heart growth, function, valves, blood flow or treatment results, but each examination should have a clear clinical purpose.
8. How long does a child’s echocardiogram take?
Many routine paediatric echocardiograms take approximately 30 to 40 minutes, although a detailed or sedated examination may take longer. The duration depends on the images required, your child’s movement and the complexity of the assessment.
9. Are there any risks associated with sedation?
If sedation is required, its risks come from the medicine and level of sedation rather than from the ultrasound waves. Possible effects include prolonged sleepiness, irritability, nausea, vomiting or breathing changes. Your child should be assessed beforehand and monitored during and after the procedure until they meet the discharge criteria.
10. Can my child return to normal activities after the scan?
After a routine awake transthoracic echocardiogram, your child can usually return to normal activities immediately. If sedation, general anaesthesia, contrast or a transoesophageal examination has been used, follow the individual recovery and supervision instructions provided by the clinical team.
Final Thoughts: Understanding the Safety of Your Child’s Echocardiogram
A standard transthoracic echocardiogram is a safe, non-invasive way to assess your child’s heart without using ionising radiation. Knowing what to expect can help you feel more prepared and support your child through the appointment with confidence.
If you’re considering echocardiography in London, you can get in touch with us at London Paediatric Clinic. A clear understanding of the process allows you to make informed decisions while keeping your child’s comfort and wellbeing a priority.
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/
- NHS (2025) Ultrasound scan. Available at: https://www.nhs.uk/tests-and-treatments/ultrasound-scan/
- Kingston and Richmond NHS Foundation Trust (2026) Echocardiogram. Available at: https://www.kingstonandrichmond.nhs.uk/patients-and-families/patient-leaflets/echo
- 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
- National Institute for Health and Care Excellence (2010) Sedation in under 19s: using sedation for diagnostic and therapeutic procedures. NICE guideline 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/
- Society of Radiographers and British Medical Ultrasound Society (2025) Guidelines for Professional Ultrasound Practice. 9th ed. Available at: https://www.bmus.org/media/resources/2025-SoR-and-BMUS-guidelines-9th-Ed-FINAL.pdf
- Great Ormond Street Hospital for Children NHS Foundation Trust (2019) ‘Your child is having an echocardiogram under sedation’. Available at: https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/your-child-having-echocardiogram-under-sedation/