Cardiovascular diseases (CVD) are the world’s leading cause of death, with an average toll of 18.6 million lives lost every year.
Although CVD are commonly associated with adulthood, the lesser-known fact is that children too are at risk of developing CVD. The most common heart disease among children is known as congenital heart defects (CHD). According to Ministry of Health, the incidence of CHD among children is about 8 to 10 per 1,000 live births. With an average of 500,000 deliveries in Malaysia each year, the number of children born with CHD is about 5,000 a year, of which two-thirds will require surgical intervention. [Source: Ministry of Health Malaysia]
CHD results when the heart, or blood vessels near the heart, do not develop normally before birth. Most congenital heart defects have no known cause. They may sometimes run in families. Some CHD may be associated with genetic disorders, such as Down syndrome, Turner syndrome and Williams syndrome, etc. Some children are predisposed to congenital heart disease if the mother has diabetes or rubella, or has taken certain medications, such as anti-epileptic drugs, during pregnancy.
Sometimes a heart defect can be diagnosed before a baby is born. However, defects are usually identified days or even months after birth, when symptoms become obvious. Less serious congenital heart defects may not be diagnosed until later in childhood because there may not be any noticeable signs and symptoms. It is also possible to have a heart defect and show no symptoms at all.
Every child deserves a healthy heart. Doctors play a critical role in identifying any potential issues and if the newborn baby is “not doing well” and having a high index of suspicion to be able to rule out a serious congenital cardiac problem which needs early intervention.
Parents and caregivers of newborns and very young children should also be aware of CHD to improve on early detection and management of the disease. Some of the most commons symptoms of serious CHD to watch out for include:
- Rapid breathing
- Bluish discoloration of the skin and mucous membranes which is commonly noticed around the lips, fingernails, palms of the hands and soles of the feet (cyanosis)
- Shortness of breath during feeding, leading to poor weight gain
- Poor growth
- Recurrent lung infection
As a result of medical advancements, the outlook for congenital heart diseases is increasingly positive. Children with CHD can survive and live into adulthood, depending on the type of birth defect. However, parents are faced with challenges that comes with caring for children with CHD who have unique and special needs.
- Heart medicines can be very strong and dangerous if not given correctly. Parents must understand how much medicine to give and how to give it. If the child takes a blood thinner, parents must have clear instructions on how to give this medicine safely.
- Ensure the child eats well and receives adequate nutrition. They often tire when eating, so they eat less and may not get enough calories.
- Preventing infections is crucial. Although an infection in the heart or endocarditis is uncommon, children with heart defects have a greater risk of developing this. Good dental hygiene goes a long way toward preventing endocarditis by reducing the risk of tooth or gum infection. Parents can get more information from cardiologist about the latest guidelines on antimicrobial prophylaxis against infective endocarditis. These children must also get all the recommended vaccinations.
- Most children with a congenital heart defect can be physically active without restrictions. In fact, children are encouraged to be physically active to keep their hearts fit and to avoid obesity, unless they have a few specific heart conditions.
- Emotional support will help children who may have self-esteem issues because of how they look. They may have scars from surgery, and they may be smaller, or have limits on how active they can be.
- As children transition to adulthood, parents can gradually teach them about their heart defect and guide them in how to care for their own health without being overly protective.
Despite the typical reaction to CHD, parents should be aware that some mild heart defects do not require any treatment. Although the more complex heart defects need medication, interventional procedures or surgery, many heart defects can be successfully managed often in early infancy.
Most children with CHD reach their adulthood. In fact, children with simple conditions may lead completely normal lives, while those with more complex conditions usually face more challenges that can nevertheless be surmounted with the right measures in place. The goal is to prevent complications, reduce the morbidity and mortality associated with heart defects, optimize and improve the quality of the lives of children with congenital heart disease.
The most common congenital heart disease is a hole in the heart known as septal defects. There are different types of septal defects depending on location and complexity such as atrial septal defects (ASD), ventricular septal defects (VSD) or AV septal defects (AVSD)
Congenital heart defects are conventionally treated by corrective surgery but certain septal defects can be closed with an occlusion device. Although congenital heart disease may pose significant challenges for the family, most cases are treatable with today’s medical breakthroughs. Any symptoms are manageable with proper medication and frequent consultation by professional healthcare practitioners.
Attributed to Dr. Choo Kok Kuan, Consultant Pediatrician and Pediatric Cardiologist, Subang Jaya Medical Centre and Dr. Kenny Cheng, Consultant Cardiothoracic Surgeon, Subang Jaya Medical Centre.