A Child Living with a Pacemaker or Implantable Cardioverter Defibrillator (ICD)
With advances in technology, implanted pacemakers and ICDs generally last 5 to 7 years
or more (depending on usage and the type of device). In most cases, a child with one
of these devices can lead a normal life. New technology has also reduced the interference
risk from machinery, such as microwaves. In the past, these items may have affected
these devices. Even so, take certain precautions when a child has an implanted pacemaker
What precautions should be taken with an implanted pacemaker or ICD?
Your child should wear a medical ID bracelet or necklace to let others know about
the device in case of emergency. When he or she is old enough to have a wallet, it
is a good idea to also carry an ID card.
The following items do not alter the function of today's pacemakers or ICDs:
Kitchen appliances such as blenders, toaster ovens, and electric knives
Televisions (including the remote control), FM and AM radios, and stereos
TV and radio transmitters
Ham radios and CB radios
Electric blankets and heating pads
Electric shavers, hair dryers, curling irons, and other personal care appliances
Gardening machinery, such as electric trimmers
Garage door openers
Metal detectors for consumer use (it is unlikely that security metal detectors will
cause harm, but don't stand next to one for long periods)
Copying and fax machines
Properly grounded shop tools (except power generators or arc welding equipment)
Cell phones and MP3 players
Typically, cell phones do not affect pacemakers or ICDs. Most devices made today have
a filter that allows the use of most cell phones throughout the world. This includes
analog and digital phones. However, the Federal Communications Commission (FCC) is
making new frequencies available for cellular phones, which may make pacemakers or
ICDs less reliable. General recommendations include keeping a cell phone at least 6
inches away from a pacemaker or ICD. Also avoid carrying a cell phone in a breast
pocket over the device. Similarly, avoid placing MP3 players and headphones close
to a pacemaker as they may cause some interference.
Make sure your child uses caution when going through security detectors at airports
and government buildings, such as courthouses. It is generally safe to go through
airport security detectors. They should not damage the pacemaker or ICD. But, tell
airport security personnel that your child has a pacemaker or ICD before he or she
goes through security. The device may set off the alarm. Also, if your child is selected
for a more detailed search, politely remind security that the hand-held metal-detecting
wand should not be held over the device for any prolonged period of time (more than a second or two).
The magnet inside the detecting wand may temporarily change the operating mode of
the device. Be prepared to show an ID card or a medical ID bracelet to pass through
The following situations may cause interference with ICDs. (Some of the activities
mentioned are not appropriate until a child nears adulthood, but may affect older
teenagers.) Discuss the following in detail with your child's doctor:
Avoid working with, holding, or carrying magnets near the pacemaker or ICD.
Avoid magnetic resonance imaging (MRI) machines or other large magnetic fields, as
these may affect the programming or function of the device. Also, the rapidly changing
magnetic field within the MRI scanner may, in theory, cause heating of the device
leads. Often, there are alternatives to MRI for persons with pacemakers, but if your
child's doctor determines that he or she absolutely needs an MRI scan, discuss this
thoroughly with your child's cardiologist before proceeding. If the cardiologist and
you decide to go ahead, your child should be closely monitored during the scan, with
a pacemaker programming device immediately available. Also, metal objects are never permitted
near MRI machines.
Abstain from diathermy (the use of heat in physical therapy to treat muscles).
Turn off large motors, such as cars or boats, when working on them, as they may temporarily
"confuse" the device. Do not use chain saws, because of the close contact with the
Avoid certain high-voltage or radar machines, such as arc welders, high-tension wires,
radar installations, smelting furnaces, electric steel furnaces, and other high-current
Avoid working in restricted spaces near radio or TV transmitting towers and antennas.
If your child is having a surgical procedure done by a surgeon or dentist, tell the
surgeon or dentist that your child has a pacemaker or ICD. Some surgical procedures
will require that your child's device be temporarily turned off or set to a special
mode. This decision will be made by your child's cardiologist. Temporarily changing
the mode on your child's device can be done noninvasively (no additional surgery is
required), but should only be done by qualified medical personnel.
Certain medical procedures may occasionally affect the function of the device, but
might be done successfully with some adjustments to the pacemaker or ICD settings.
These procedures include the following:
Extracorporeal shock-wave lithotripsy (ESWL). A procedure that dissolves kidney stones.
Transcutaneous electrical nerve stimulation (TENS). A device used to relieve acute or chronic pain.
Therapeutic radiation treatments for cancer
Consult your child's doctor before your child undergoes these procedures.
Always consult your child's doctor if you have any questions concerning the use of
certain equipment near your child's pacemaker.
Can my child participate in regular, daily activities with a pacemaker or ICD?
Once the device has been implanted, your child should generally be able to do the
same activities as other people in the same age group. Your child's doctor will provide
activity instructions specific to your child.
However, when involved in a physical, recreational, or sporting activity, a child
with a pacemaker or ICD should avoid receiving a blow to the area over the pacemaker.
A blow to the chest or abdomen near the pacemaker or ICD can affect its functioning.
Contact sports are usually not recommended for children with pacemakers or ICDs for
this reason. If your child does receive a blow to that area, contact your child's
doctor. Consult your child's doctor for activity restrictions.
Always consult your child's doctor when he or she feels ill after an activity, or
when you have questions about beginning a new activity.
How can I ensure that my child's pacemaker or ICD is working properly?
Although your child's device is built to last 5 to 7 years, always have it checked
regularly to ensure that it is working properly. Different doctors may have different
schedules for checking devices. Most are checked in the home using a telephone and
special equipment provided by your child's device manufacturer. Your child's doctor
will recommend in-person device checks at specific intervals as well. Any device setting
changes must be made in person, by a trained medical professional, using a device
Battery life, lead wire condition, and various functions are checked by doing what
is called "device interrogation". During an interrogation, the device is noninvasively
connected to a device programmer using a special wand placed on the skin over the
pacemaker or ICD. The data is transmitted from the device to the programmer and evaluated. Most
in-home device interrogation systems use wireless technology to connect the device
to special equipment that records the data and sends it to your child's doctor.
Your doctor may ask you to check your child's pulse rate periodically. Report any
unusual symptoms, or symptoms similar to those your child had prior to the device
insertion, to your child's doctor immediately.
Always consult your child's doctor for more information, if needed.
What is the pulse?
The pulse rate is a measurement of the heart rate, or the number of times the heart
beats per minute. As the heart pushes blood through the arteries, the arteries expand
and contract with the flow of the blood. This can be felt in various points in the
body as a pulse. Taking a pulse not only measures the heart rate, but also can indicate
Heart rhythm (abnormal rhythm may indicate a heart disorder or arrhythmia)
Strength of the pulse (a weak pulse may indicate a fast heartbeat in which some beats
are too weak to feel, heart failure, or a low volume of blood in the circulatory system)
Many pacemakers provide varying rates, depending on your child's activity level and
other factors. The pulse rate may fluctuate and increase with exercise, illness, injury,
and emotions. Teenage girls and women, in general, tend to have faster heart rates
than do boys and men of the same age. Athletes, such as runners, who do a lot of cardiovascular
conditioning may have naturally slow heart rates.
How to check your child's pulse
As the heart forces blood through the arteries, you can feel the beats by firmly pressing
on an artery. Your arteries are located close to the surface of the skin at certain
points of the body. The pulse can be found on the side of the lower neck, on the inside
of the elbow, or at the wrist. When taking a pulse:
Using the first and second fingertips, press firmly but gently on the arteries until
you feel a pulse. Do not use your thumb to feel for the pulse.
Begin counting the pulse when the clock's second hand is on the 12.
Count the pulse for 60 seconds (or for 15 seconds and then multiply by 4 to calculate
beats per minute).
When counting, do not watch the clock continuously, but concentrate on the beats of
the pulse. If you have trouble with this method, try a digital kitchen timer and set
it for 1 minute. Stop counting when the timer alarms.
If unsure about your results, ask another person to count for you.
It may be better to check the wrist (radial artery) pulse than a neck (carotid artery)
pulse. If you must check a neck pulse, do not press hard on the neck, and never press
on both sides of the neck at the same time; this can cause some people to pass out
from cutting off blood supply to the brain.
If you are having trouble finding your child's pulse, consult your child's doctor