Small babies, especially those with holes in the heart, have more specific food requirements and may need special milk.
Children and adults with congenital heart disease are at an increased risk of having a heart infection. Whilst this is rare the chances of it occurring can be reduced by taking precautions.
Infections in the heart can occur for no apparent reason but are more common if the teeth are rotten - germs spread into the blood stream and infect the heart. Good dental hygiene is therefore important as are regular visits to the dentist.
If dental treatment is required, some procedures can cause germs to spill into the blood and infect the heart. It is therefore important that the dentist is informed about the heart condition before treatment. The usual method of avoiding this problem is to give a single dose of antibiotics one hour prior to the treatment to kill any germs beforehand.
Exercise is important even in those with heart disease. It improves the heart function and general sense of well-being. It is associated with an increased life expectancy and a reduced risk of heart disease later in life. In addition, physical activity helps with controlling weight and reducing blood pressure.
There are different types of exercise. In static exercise, the muscles contract but there is little joint movement e.g. weight lifting. In dynamic exercise, the muscles contract and also move the joints, e.g. running. Each places a different stress on the body and cardiovascular system. In general, most types of sports are a mix of the two.
Children usually take part in more rigorous exercise at school as they grow older. In Singapore, physical education (PE) tends to focus on game skills rather than competitive sports. However, pupils may take sport for their co-curricular activities (CCA), where training is more intense and competitive. Training for the NAPFA test is also intensive, and some pupils with heart problems may have difficulty with the 2.4k run as they often perform less well at endurance-type activities.
As always, parents or patients must seek the advice of their own doctors when deciding how much exercise is safe, particularly as there are no published guidelines for activity levels in children.
The Bottom Line
- Most children with heart conditions (even following surgery) can safely participate in sport at all levels
- Some children with complex heart problems should restrict themselves to certain sports
- Competitive sport should not be undertaken by some children
- A certain level of fitness is healthy and should be encouraged for all children
Most children with heart disease can have all the normal vaccinations at the appropriate time.
However, some children with an immune deficiency (DiGeorge syndrome or an isomerism), and those who are receiving immunosuppression - for instance, following transplantation, require a different vaccination schedule.
Before travelling anywhere unusual or a long distance make sure that you:
- Have a recent medical check up
- Have appropriate insurance cover
- Have an adequate supply of medicine
- Are aware of the quality of and access to the local health care of the country you are visiting
- Carry the relevant documentation about the heart condition
Those with cyanotic heart disease ("blue" due to reduced oxygen in the blood), can still travel but aircraft at altitude have less oxygen in the air than at ground level, and so the blueness may be more apparent. This does not usually cause symptoms, but if necessary, airlines can arrange for additional oxygen to be available on the aircraft.
For long aircraft flights, it is sensible to use support stockings and take aspirin or an equivalent unless your doctor advises against it.
Special diets are not normally necessary for those with heart disease. As it is with everyone, it is important to have a balanced diet and not to eat to excess. It is, however, important to maintain a normal weight - excess weight means more work for the heart.
Most children with heart disease are no more prone to infections than any other children. Some, however, are likely to get chest infections - particularly those with holes in the heart (ASD, VSD, PDA)
In addition, some heart diseases are also associated with an immune deficiency, and infections therefore are more common. The majority of childhood infections are viruses and get better without antibiotics. In any case of doubt, professional medical help should be sought, and the doctor will decide if antibiotics are necessary.
Most children with heart disease do not require medication. Some, however, need them to:
- Reduce their body fluids
- Assist the pumping action of the heart
- Control rhythm problems
- Thin the blood
The majority of these medicines have been used for many years and are very safe, but like all drugs side effects may occur especially if there is another illness or a change in other medication. If unusual symptoms or side-effects occur whilst on medication, it is important to inform the doctor immediately.
Most women with heart disease are able to undergo a normal pregnancy and delivery.
The exceptions are those with severe cyanosis, where there is an usually insufficient amount of oxygen in the blood supply to the placenta to sustain the baby. Most of these pregnancies spontaneously abort.
Women with pulmonary hypertension (high lung artery pressure) are not usually advised to get pregnant as there is a serious danger to their life.
As with any medical problem, it is essential that medical advice be taken, preferably before pregnancy so it can be monitored and if treatment is necessary, it can be undertaken early.
If a woman has a heart problem, then there is an increased risk that her child will have a similar problem. The risk is around 6%. If a man has a heart problem, the risk is 2%. If the couple have had a previously affected child, the risk is also about 2%.
The risks quoted above are averages - the actual risk varies considerably between the various heart conditions. There is also some evidence that taking vitamins for 3 months prior to, and in the first 3 months of the pregnancy can reduce the chance of heart disease occurring in the baby.