It is understandable to feel worried when your child complains of chest pain, feels their heart racing or is found to have a heart murmur. You may immediately start wondering whether these signs mean there is a serious problem with your child’s heart, but many childhood symptoms have causes that are not related to significant heart disease.
In many cases, symptoms such as chest discomfort, dizziness or a heart murmur that appears likely to be innocent do not indicate a serious heart condition. However, you should seek specialist advice when symptoms happen during exercise, become more frequent, occur alongside fainting or breathlessness, or appear with a concerning family history. A paediatric cardiologist can assess your child’s symptoms, examine their heart and arrange tests such as an ECG or echocardiogram when needed.
What Does a Paediatric Cardiologist Assess?
A paediatric cardiologist assesses suspected and confirmed heart conditions in children and young people. They investigate concerns such as heart murmurs, abnormal heart rhythms, inherited heart conditions and symptoms that may be related to the heart or circulation.
The specialist also considers how your child’s heart health may affect feeding, growth, breathing and physical activity. Normal heart findings vary with age, so every assessment is interpreted using age-appropriate standards.
Children are commonly referred because of chest pain, palpitations, fainting, a heart murmur or a family history of heart disease. The assessment helps determine whether further tests, treatment, monitoring or simple reassurance are needed.
A Referral Does Not Always Mean Heart Disease
Being referred to a paediatric cardiologist does not automatically mean your child has a serious heart condition. Many children are referred so that a specialist can assess their symptoms and rule out significant heart disease.
Symptoms such as chest discomfort and dizziness often have non-cardiac causes, while an innocent heart murmur does not indicate an underlying heart condition. The cardiologist considers your child’s medical history, examination findings and any investigations before deciding whether the symptoms are related to the heart.
If no significant heart problem is found, your child may not need treatment or long-term follow-up. Many families leave the appointment reassured that their child’s heart is healthy.
A Heart Murmur Is a Common Reason for Referral
A heart murmur is an extra sound heard when blood flows through the heart. Although hearing that your child has a murmur can be worrying, many childhood murmurs are innocent and occur in children with completely normal hearts.
A paediatric cardiologist assesses the murmur alongside your child’s age, symptoms, oxygen levels, growth and examination findings. While many murmurs require only reassurance, some may need further investigation to rule out an underlying heart condition.
Seek prompt medical advice if a murmur occurs alongside poor feeding, rapid breathing, excessive sweating during feeds, poor weight gain, fainting or blue or grey colouring. These symptoms may indicate that further assessment is needed.
Most Childhood Chest Pain Is Not Caused by the Heart
Chest pain is one of the most common reasons children are referred to a paediatric cardiologist, but it is rarely caused by a heart condition. In many cases, the pain comes from muscles, ribs, breathing problems, digestive issues or anxiety rather than the heart.
Medical assessment is more important when chest pain occurs during exercise or is accompanied by fainting, palpitations, significant breathlessness or a family history of inherited heart disease. Your child’s doctor will decide whether referral to a paediatric cardiologist is appropriate.
Call 999 if your child develops severe chest pain with collapse, major breathing difficulty or suddenly becomes blue or grey. Otherwise, most children can first be assessed by a GP or paediatrician, who will decide if specialist review is needed.
Palpitations and Heart Rhythm Problems
Palpitations are sensations that make your child notice their heartbeat, such as pounding, fluttering, skipping beats or a sudden racing heartbeat. In many children, palpitations occur during exercise, excitement, fever, stress or dehydration and settle once the trigger passes.
Medical assessment is more important when episodes start and stop suddenly, happen repeatedly, last longer than usual or occur with chest pain, fainting, significant breathlessness or a family history of heart rhythm problems. Younger children may show signs such as pallor, unusual tiredness, breathlessness or becoming unsettled rather than describing the sensation clearly.
A paediatric cardiologist may recommend an ECG or heart-rhythm monitor if an abnormal rhythm is suspected. Most childhood palpitations are not caused by a serious rhythm disorder, but assessment helps identify the small number of children who need further monitoring or treatment.
Fainting in Children
Fainting is common in children and teenagers and is often caused by a temporary reduction in blood flow to the brain. Dehydration, heat, prolonged standing, pain and emotional stress are common triggers, and many children feel dizzy, sick or develop blurred vision before fainting.
Seek medical advice if fainting happens repeatedly, occurs without a clear trigger, causes injury or is associated with chest pain, palpitations or significant breathlessness. A specialist assessment may be recommended when the pattern suggests a possible heart-related cause.
Fainting during exercise is a more important warning sign and should be assessed promptly. Your child should avoid strenuous or unsupervised exercise until they have received medical advice, particularly if the episode occurred while actively running, swimming or playing sport.
Breathlessness, Feeding Difficulties and Blue Colouring
Children naturally breathe faster during exercise, play or anxiety, but breathlessness may need assessment when it seems out of proportion to activity, occurs at rest or wakes your child from sleep. Other concerning signs include unusual tiredness, difficulty keeping up with other children, taking frequent breaks during activity or recovering very slowly after exercise.
In babies, feeding can become difficult if the heart is working harder than expected. Warning signs include rapid breathing during feeds, sweating while feeding, frequent pauses, tiring before finishing a feed and poor weight gain. Feeding problems should be assessed promptly, especially when they occur with a heart murmur or persistent breathlessness.
A blue or grey colour affecting the lips, tongue or skin can indicate a problem with oxygen levels or circulation and requires urgent medical attention if it is new or unusual for your child. Call 999 if your child becomes blue or grey, has severe breathing difficulty, collapses or is difficult to wake.
An Unusual Pulse or Heart Rhythm May Need Checking
A healthcare professional may recommend a paediatric cardiology assessment if they notice that your child’s pulse is unusually fast, slow or irregular. The importance of this finding depends on several factors, including your child’s age, overall health, symptoms and what they were doing at the time the rhythm change was noticed.
Ongoing rhythm changes or an abnormal ECG should be reviewed by an appropriately trained specialist. Further tests may be arranged if needed to decide whether monitoring, treatment or reassurance is appropriate.
Your Family History Can Affect the Referral Decision
Your child’s family history can help doctors decide whether a paediatric cardiology referral is needed. Tell your child’s doctor if close relatives have cardiomyopathy, inherited heart rhythm disorders, aortic disease or another inherited heart condition.
It is also important to mention an unexplained sudden cardiac death or cardiac arrest in a young family member, particularly before the age of 40. This information may affect whether your child needs specialist assessment. A paediatric cardiologist can decide whether further tests or monitoring are appropriate based on your child’s symptoms and family history.
Children Can Be Screened for Inherited Heart Conditions
Some children are offered heart screening even when they have no symptoms because of a family history of inherited heart disease. Screening helps identify early signs and determine whether ongoing monitoring is needed.
Depending on the condition, your child may have tests such as an ECG, echocardiogram or heart rhythm monitoring. Genetic counselling or genetic testing may also be discussed in some families. Being offered screening does not mean your child has inherited a heart condition. Many children have normal results and only require reassurance or routine follow-up.
Some Children Need Ongoing Cardiac Follow-Up
Children with congenital heart disease or certain acquired heart conditions may need regular follow-up with a paediatric cardiologist, even when they appear well. Ongoing reviews help monitor heart function and detect any changes over time.
The type of follow-up depends on your child’s condition and may include clinic reviews, imaging or other heart investigations. Some children need only occasional appointments, while others require longer-term monitoring. Attending scheduled appointments helps ensure your child receives the right care and allows treatment to be adjusted if needed.
Other Medical Conditions Can Justify Heart Screening
Some genetic syndromes, metabolic disorders and neuromuscular conditions can increase the risk of heart problems. Your child’s specialist may recommend cardiac screening even if there are no symptoms.
This type of assessment is preventive and helps establish a baseline of your child’s heart health. Regular screening can detect changes before they cause problems. The investigations recommended will depend on your child’s medical condition and may include an ECG, echocardiogram or other heart tests.
Your GP or Paediatrician Will Decide the Urgency of Referral
Your GP or paediatrician is usually the first healthcare professional to assess your child’s symptoms. They will take a medical history, examine your child and decide whether reassurance, monitoring or referral to a paediatric cardiologist is appropriate. Initial tests such as an ECG may sometimes be arranged before referral.
Not every referral is urgent. Children with suspected innocent heart murmurs or mild symptoms without warning signs can usually be seen routinely, while symptoms such as exercise-related collapse, severe breathlessness or concerning findings in young babies may require more urgent specialist assessment.
Giving clear information about when the symptoms occur, how long they last and whether they are associated with chest pain, fainting, palpitations or breathlessness helps the doctor decide how quickly your child should be reviewed.
Know When Emergency Care Is More Appropriate
You should not wait for a routine cardiology appointment if your child appears seriously unwell. Call 999 if your child collapses and does not recover normally, has severe breathing difficulty, suddenly becomes blue or grey, or is unusually difficult to wake. These symptoms require immediate medical assessment.
Children with severe chest pain accompanied by collapse, significant breathlessness or reduced responsiveness should also receive emergency medical care. If your child already has a diagnosed heart condition, follow the personalised emergency advice provided by their cardiology team.
What Happens During a Paediatric Cardiology Assessment?
The paediatric cardiologist will ask about your child’s symptoms, medical history and any family history of heart disease. They will also examine your child’s pulse, heart sounds, breathing and circulation.
Depending on the symptoms, your child may need tests such as an ECG, echocardiogram or heart rhythm monitoring. Not every child will need every investigation. After the assessment, the cardiologist will explain the findings and whether your child needs reassurance, further tests or ongoing follow-up.
How to Prepare for the Appointment
Before the appointment, make a note of when your child’s symptoms occur, how long they last, what triggers them and whether they are associated with chest pain, fainting, breathlessness or palpitations. Bringing details of medicines, previous test results and relevant hospital letters can also be helpful.
If there is a family history of inherited heart disease or unexplained sudden death, let the cardiologist know. Older children should also be encouraged to describe their symptoms in their own words, as this can provide valuable information during the assessment.
What Happens After the Assessment?
After the assessment, the cardiologist will explain the findings and whether any further care is needed. Many children are reassured and discharged without treatment, while others may need follow-up appointments, medicines or additional investigations depending on the diagnosis.
Your child will only be advised to restrict exercise if there is a medical reason to do so. If activity restrictions are needed, the cardiology team will explain which activities should be avoided and when it is safe to return to normal exercise.
Myth vs Fact
| Myth | Fact |
| A cardiology referral means that my child has a serious heart problem. | Many children are referred for assessment and are later reassured that no significant cardiac condition has been found. |
| Every childhood heart murmur means there is a hole in the heart. | Many murmurs are innocent sounds caused by normal blood flow. Further testing depends on the child’s symptoms and examination findings. |
| Chest pain in children usually comes from the heart. | Most childhood chest pain has a non-cardiac cause, but pain during exercise or pain associated with fainting or palpitations needs careful assessment. |
| Every faint requires a heart specialist. | Many faints are related to dehydration, heat or prolonged standing. Fainting during exercise or with cardiac warning signs requires more urgent evaluation. |
| A normal ECG rules out every rhythm problem. | An ECG records only a short period. Intermittent rhythm problems may require longer monitoring. |
| A child without symptoms cannot have an inherited heart condition. | Some inherited cardiac conditions may be present before obvious symptoms develop, which is why screening may be recommended for certain families. |
Key Takeaways
- A paediatric cardiology referral does not automatically mean that your child has heart disease.
- Many childhood murmurs, chest pains and faints have non-cardiac causes.
- Symptoms occurring during exercise require more careful assessment.
- Recurrent sudden palpitations may need longer heart-rhythm monitoring.
- Family history may justify screening even when a child has no symptoms.
- Your GP or paediatrician is usually the appropriate first contact for stable symptoms.
- Call 999 for severe breathing difficulty, poor recovery after collapse, difficulty waking or sudden blue or grey colouring.
Frequently Asked Questions
1. When should your child see a paediatric cardiologist?
You should consider a paediatric cardiology assessment if your child experiences symptoms such as chest pain during exercise, repeated palpitations, fainting, unusual breathlessness or a concerning heart murmur. Your GP or paediatrician can help decide whether your child needs specialist review.
2. Does a referral to a paediatric cardiologist mean your child has heart disease?
A referral does not always mean your child has a heart condition. Many children are referred so that a specialist can check their heart health, rule out concerns and provide reassurance.
3. Are heart murmurs in children always a sign of a heart problem?
Many childhood heart murmurs are harmless and happen because of normal blood flow through the heart. However, further assessment may be needed if the murmur has concerning sound characteristics or occurs with poor feeding, breathlessness, poor growth, fainting, abnormal pulses or low oxygen levels.
4. Should you worry if your child complains of chest pain?
Most chest pain in children is not caused by a heart problem and may be related to muscles, ribs, breathing issues or digestion. You should seek medical advice if your child’s chest pain happens during exercise or occurs with fainting, palpitations or breathlessness.
5. When do palpitations in children need specialist assessment?
Palpitations can happen due to normal changes caused by exercise, excitement, fever or stress. You should seek medical advice if your child experiences sudden racing heartbeats, repeated episodes, dizziness, fainting, chest pain or symptoms that affect daily activities.
6. Is fainting in children always linked to a heart condition?
Many children faint because of common triggers such as dehydration, heat, standing for a long time or emotional stress. You should arrange medical advice if fainting happens during exercise, occurs repeatedly or is accompanied by chest pain or palpitations.
7. What tests may your child have during a paediatric cardiology assessment?
Your child may have tests such as an electrocardiogram (ECG), echocardiogram or heart rhythm monitoring depending on their symptoms. These investigations help the specialist understand the heart’s structure, rhythm and function.
8. When should you seek urgent help for your child’s heart symptoms?
Call 999 if your child collapses and does not recover normally, has severe breathing difficulty, suddenly becomes blue or grey, is unusually difficult to wake or has severe chest pain accompanied by breathlessness, collapse or reduced responsiveness. These signs may require immediate assessment.
9. Can your child have a heart condition without obvious symptoms?
Some children with inherited heart conditions or certain congenital heart problems may not show clear symptoms. If your child has a family history of heart disease or unexplained sudden death, specialist screening may be recommended.
10. How can you prepare for your child’s paediatric cardiology appointment?
You can prepare by noting when your child’s symptoms occur, how long they last and what triggers them. Bringing details of medicines, previous medical reports and family heart history can help the cardiologist make a more accurate assessment.
Final Thoughts: Knowing When Your Child Needs Specialist Heart Care
Many symptoms that lead to a paediatric cardiology referral, including heart murmurs, chest pain and fainting, are not caused by serious heart disease. However, symptoms that occur during exercise, repeated palpitations, unexplained breathlessness or a significant family history should always be assessed appropriately.
If your child needs further evaluation, an experienced paediatric cardiologist in London can provide specialist assessment, arrange appropriate investigations and explain the results clearly. Early assessment helps ensure children who need treatment receive it promptly while providing reassurance for families when the heart is healthy.
References:
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- Friedman, K.G. and Alexander, M.E. (2013) ‘Chest pain and syncope in children: A practical approach to the diagnosis of cardiac disease’, The Journal of Pediatrics, 163(3), pp. 896–901.e1–e3. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3982288/
- Goto, L., Witkowska, O., Slusarczyk, M.E., Grotek, A.M., Dziubinski, M.J. and Clark, B.C. (2023) ‘Diagnostic yield of ambulatory cardiac monitoring in pediatric patients with palpitations’, Annals of Pediatric Cardiology, 16(2), pp. 109–113. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10522156/
- Great Ormond Street Hospital for Children NHS Foundation Trust (no date) Screening for cardiac conditions. Available at: https://www.gosh.nhs.uk/wards-and-departments/departments/clinical-specialties/inherited-cardiovascular-diseases/screening-cardiac-conditions/
- Leeds Teaching Hospitals NHS Trust (2025) Regional Inherited Cardiac Conditions Service. Page last reviewed 2 April 2025. Available at: https://www.leedsth.nhs.uk/services/congenital-heart-unit/leeds-congenital-hearts-children-and-teenagers/regional-inherited-cardiac-conditions-service/
- NHS (2025) Congenital heart disease. Page last reviewed 11 December 2025. Available at: https://www.nhs.uk/conditions/congenital-heart-disease/
- NHS (2023) Blue or grey skin or lips (cyanosis). Page last reviewed 4 October 2023. Available at: https://www.nhs.uk/symptoms/blue-skin-or-lips-cyanosis/
- Patel, S., Sedaghat-Yazdi, F. and Perez, M. (2018) ‘Management of pediatric chest pain, palpitations, syncope, and murmur presenting to the emergency department’, Clinical Pediatric Emergency Medicine, 19(4), pp. 328–339. Available at: https://www.sciencedirect.com/science/article/pii/S152284011830079X
- Sanatani, S., Chau, V., Fournier, A., Dixon, A., Blondin, R. and Sheldon, R.S. (2017) ‘Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association position statement on the approach to syncope in the pediatric patient’, Canadian Journal of Cardiology, 33(2), pp. 189–198. Available at: https://www.sciencedirect.com/science/article/pii/S0828282X16309783