Physical Exam for a Child with Congenital Heart Disease

Your child's healthcare provider will do an exam when diagnosing or assessing heart conditions. A physical exam can help find possible heart conditions. Or it can help find out how well your child is coping with existing heart problems. This exam may include a head-to-toe assessment.

Some of the areas that may mean a problem with your child's heart health include the following.

The healthcare provider will check the soft spot on the top of your baby's head (anterior fontanelle). The soft spot is felt throughout the first year of life. Normally this soft spot is flat, soft, and level with the rest of the scalp. The soft spot on the top of a baby's head is checked to find out if your baby is dehydrated. If the child is dehydrated, the soft spot may be sunken.

• The nostrils will be looked at as your child breathes. Many heart defects present at birth (congenital) can stress the lungs. This causes trouble with breathing. Your child's healthcare provider can check how serious the problem is by watching whether your child's nostrils flare (dilate) as they breathe. When the lungs are working hard, the nostrils may open up wide as a way to take in extra air.

• Lip color is an important marker of heart disease. Normally the inside of the lips are a pink color. A blue or purple color (cyanosis) means low levels of oxygen in the blood. It may also mean not enough blood is flowing because of heart failure, anemia, or blood loss.

The jugular veins and the carotid arteries are located on either side of the neck. The jugular veins bring blood from the head back to the heart for a new supply of oxygen. The carotid arteries take oxygen-rich (red) blood to the brain. Veins and arteries that are easily visible in the neck while a child is resting may be a sign that the heart isn't pumping blood well.

Your child's healthcare provider will watch and feel your child's chest. The provider will also use a stethoscope to listen to the heart and lungs. 

• Difficult breathing can be caused by heart defects that are present at birth (congenital). One of the problem signs that can be seen is called retractions. This is when the muscles between or below the ribs or above or below the breastbone pull inward each time a child breathes.

• Your child's healthcare provider will listen carefully to the front and back of your child's chest with a stethoscope. They will also check the heart in several different areas of the chest. The provider will listen for heart rates within the normal range, abnormal sounds such as certain murmurs or clicks, and irregular beats. Heart sounds can also be heard in the back. The provider will also count the heart rate.

• Abnormal sounds may be heard in the lungs when heart disease is present. Fluid may build up in the lungs with some heart problems. Your child's healthcare provider will hear crackles, congestion, or other moist or "wet" sounds. Both lungs should have sounds that mean good airflow is moving through them. Breathing sounds that are not as clear or strong in one lung as in another will need further assessment. The provider will also count the breathing rate. Fluid in the lungs may cause a child to breathe faster than normal.

Many heart problems can cause problems with the body's water balance. This can cause your child to retain water, which can lead to swelling. The liver is one of the organs that becomes swollen when the body's water balance is abnormal. Your child's healthcare provider will feel the right side of the belly to see if the liver is enlarged. They will also check for swelling of the organ.

Your child's healthcare provider will feel your child's arms and legs to check pulses. Pulses can be found in each arm on the inside of the wrist, in the bend of the elbow, and on the inner surface of the upper arm. In the legs, pulses can be found on each side of the groin, behind the knee, on the top of the foot, and behind the inner ankle. Absent or overly strong pulses may mean heart problems.

• Skin temperature is also helpful to assess heart disease. When the heart isn't pumping well, it won't be able to pump enough blood to meet the body's demands. The body will limit blood flow to nonessential areas such as the arms and legs. This helps protect the brain, heart, and kidneys. The skin may become very pale and cool to the touch in this case.

• The nail beds also show important information about the heart. Normally the nails are a pink color. Blue or purple nails mean there's not enough oxygen in the blood or not enough blood in circulation. Pale nail beds may mean too few red blood cells in the bloodstream (anemia). Children with cyanotic congenital heart disease may have widened nail beds (clubbing). This heart problem lets blood that should go to the lungs instead flow to the body.

Other factors that may be considered during the exam include:

• Growth and development. The healthcare provider will check to see if your child’s height and weight are as expected for their age. They will also want to know if your child is meeting development targets for their age, such as walking and talking.

• Activity level. The healthcare provider will want to know if your child is active and busy, or if they tire easily. Let the provider know if activities such as walking or playing cause shortness of breath.

• Blood pressure. The healthcare provider will check to see if there is a difference in blood pressure between the upper and lower extremities.

The symptoms of heart disease may look like other health problems. Always see your child's healthcare provider for more information.