Physical Exam for a Child with Congenital Heart Disease
Your child's physical exam
Your child's doctor will do an exam when diagnosing or evaluating heart conditions.
This exam may include a head-to-toe assessment. A physical exam can help detect possible
heart conditions, or help determine how well your child is coping with existing heart
Some of the areas that may indicate a problem with your child's heart health include
The doctor will check the soft spot on the top of your infant's head, known as the
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 an infant's head is examined to determine if there are dehydration problems.
If the child is dehydrated, the soft spot may be sunken.
The nostrils will be examined as your child breathes. Many congenital (present at
birth) heart defects can stress the lungs, causing trouble breathing. Your child's doctor
can check the degree of the problem by watching whether your child's nostrils flare
as he or she breathes. 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 indicator of heart disease. Normally, the inside of the
lips are a pink color. A blue or purple color means low levels of oxygen in the blood.
It may indicate not enough blood is flowing due to heart failure, anemia, or blood
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 back 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 efficiently.
Your child's doctor will observe and feel your child's chest as well as use a stethoscope
to listen to the heart and lungs.
Difficult breathing can be caused by congenital (present at birth) heart defects.
One of the problem signs that can be observed is retraction--a pulling inward of the muscles
between or below the ribs, or above or below the breastbone each time a child breathes.
Your child's doctor will listen carefully to the front and back of your child's chest
with a stethoscope. He or she will listen to the heart in several different areas
of the chest for abnormal sounds, such as certain murmurs, clicks, and irregular beats.
Heart sounds can also be heard in the back. The heart rate will also be counted.
Abnormal sounds may be heard in the lungs when congenital or acquired heart disease
is present. Fluid may build up in the lungs with some heart problems, and your child's
doctor will hear crackles, congestion, or other moist or "wet" sounds. Both lungs
should have sounds indicating good airflow through them. Breathing sounds that are
not as clear or strong in one lung as in another will need further evaluation. The
breathing rate also will be counted. Fluid in the lungs may cause a child to breathe
more rapidly than normal.
Many congenital or acquired heart problems can cause problems with the body's water
balance, leading to fluid retention and swelling. The liver is one of the organs that
becomes swollen when the body's water balance is abnormal. Your child's doctor will
feel the right side of the abdomen to see if the liver is enlarged and evaluate for
swelling of the organ.
The arms and legs
Your child's doctor 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 surface of the foot, and behind the inner
ankle. Absent or overly strong pulses may indicate heart problems.
Skin temperature is also helpful in evaluating heart disease. When the heart is not
pumping effectively, it will not be able to pump enough blood to meet the body's demands.
The body will restrict blood flow to nonessential areas, such as the arms and legs,
to protect the brain, heart, and kidneys. The skin may become abnormally pale and
cool to touch in this situation.
Examination of the nailbeds also reveals important information about the heart. Normally,
the nails are a pink color. Blue or purple nails indicate insufficient amounts of
oxygen in the bloodstream, or inadequate amounts of blood in the circulation. Pale
nailbeds may indicate anemia (low numbers of red blood cells in the bloodstream).
Children with cyanotic congenital heart disease, which allows unoxygenated blood to
flow to the body, may also develop a widening of the nailbeds called clubbing.
Other factors that may be considered during the exam include:
Growth and development status. Are the child’s height and weight as expected for his
or her age? Is the child meeting development targets for his or her age, such as
walking, talking, etc.?
Activity level. Is the child active and busy, or does he or she tire easily? Do activities,
such as walking or playing, cause shortness of breath?
The symptoms of heart disease may look like other medical conditions or problems.
Always see your child's healthcare provider for more information.