American Academy of Pediatrics: All Children Should Be Screened for Potential Heart-Related Issues

Pediatricians can help detect risks in children and teens to prevent sudden cardiac death or sudden cardiac arrests

The American Academy of Pediatrics calls for all children to be screened for conditions that can lead to cardiac arrest or death, regardless of their athletic status and particularly as they enter middle school or junior high school.

In a policy statement, AAP describes the screening – which consists of four questions -- and offers new guidance to help pediatricians identify children at risk for heart-related problems as an update to 2012 recommendations. The statement, “Sudden Death in the Young: Information for the Primary Care Provider,” focuses on preventing sudden cardiac arrest and sudden cardiac death and will be published in the July 2021 Pediatrics (published online June 21).

“We tended to focus on athletes in the past when parents brought their children and teens in for a sports physical, or preparticipation exam,” said Christopher C. Erickson, MD, FAAP, lead author of the statement. “We know today that all children and teens benefit from a simple screening to help identify any potential problem that warrants follow-up with a cardiac specialist.”

The policy statement was developed by the AAP Section on Cardiology and Cardiac Surgery and the Pediatric and Congenital Electrophysiology Society (PACES) Task Force on Prevention of Sudden Death in the Young.

About 2,000 individuals younger than age 25 die each year of sudden cardiac death in the in the United States, excluding sudden infant deaths. While autopsy studies show that most patients had structural heart anomalies, the causes for 6%-40% of deaths remain unexplained.

The updated statement contains a comprehensive review of conditions that should prompt more attention and cardiology evaluation. It reviews four screening questions that are recommended, not just for athletes, but for all children.

“Ideally, this screening is incorporated into a child’s regular exam at least every two to three years,” said Jack C. Salerno, MD, an author of the statement. “The pediatrician is in an ideal position to check on a child’s development into the teenage years and is aware of family history that may raise a red flag for potential heart related issues.”

The AAP recommends:

• Pediatricians and other primary care providers should evaluate if a patient’s clinical history, family history, and physical examination suggests a risk for sudden cardiac arrest or sudden cardiac death.
• If there is a concern, an electrocardiogram should be the first test administered, and it should be interpreted by a physician trained to recognize electrical heart disease. The doctor should factor in a patient’s clinical history and consider referral to a specialist.
• Pediatricians should advocate for emergency action plans and CPR training within the community. The use of automated external defibrillators is effective, as well, in cases of sudden cardiac arrest.
• The screening itself consists of four questions that ask if a child or teen has ever fainted or had an unexplained seizure or experienced chest pain or shortness of breath, as well as if family members have a history of cardiac conditions or death before age 50.

“No single screening strategy will detect every possible heart issue, and so it’s important that we raise awareness and education not only in pediatric offices but within the community,” Dr. Erickson said. “We encourage parents and pediatricians to be alert for any concerning signs or family history.”

Information for parents is available on HealthyChildren.org here.

To request an interview, contact AAP Public Affairs.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.