Patient Care

Endocarditis (Children)

What is Endocarditis in Children?

Children with congenital heart disease are at an increased risk of having Endocarditis (an infection of the inner heart lining). Whilst this is rare, the chances of it occurring can be reduced by taking precautions.

What are the signs & symptoms of Endocarditis in Children?

Endocarditis causes symptoms of tiredness, sweating, diminished appetite, and weight loss. This usually occurs over a period of a few weeks but if the infection is severe, symptoms may sometimes occur within days. If this problem is suspected, it is important to seek urgent medical advice.

How is Endocarditis in Children diagnosed?

Blood tests are undertaken to try and identify the germ causing the infection, and a heart scan is conducted to see the effect it has had on heart function.

What are the treatment options for Endocarditis in Children?

The treatment depends upon the findings of the investigations, and the severity of the infection. Antibiotics are usually prescribed for a period of 4-6 weeks with the initial treatment given intravenously.

Fortunately, Endocarditis is usually curable, given the antibiotics that are currently available.

Caring for children with Endocarditis?

The following are some things to look out for when caring for children with Endocarditis.

Dental Care

Children 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 then 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 to the patient 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 increased life expectancy and a reduced risk of heart disease in later 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 teach games 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 2.4km run as they often perform less well at endurance type activities.

As always, parents or patients must seek the advice of their own doctor when deciding how much exercise and to what level is safe as there are currently no published guidelines for activity levels in 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 example following transplantation) require a different vaccination schedule.

Travel Advice

Before travelling anywhere unusual or a long distance, make sure that your child has:

  • A recent medical check up
  • Appropriate insurance cover
  • An adequate supply of medicine
  • Access to quality local health care at the travel destination
  • Relevant documentation about his/her heart condition

Those with cyanotic heart disease ("blue" due to reduced oxygen in the blood) can still travel. However, 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.


Special diets are not normally necessary for those with heart disease. As 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. In particular, those with holes in the heart.

In addition, some heart diseases are also associated with an immune deficiency. Infections therefore are more common. The majority of childhood infections are viruses and get better without antibiotics. In case of any doubts, professional medical help should be sought, and the doctor will decide if antibiotics are necessary.


Most children with heart disease do not require medication. However, some are required to:

  • Reduce body fluids
  • Assist with the pumping action
  • 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. This is 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.

Find A Doctor

Click here to access our Find A Doctor directory for a list of doctors treating this condition across our NUHS institutions.

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National University Health System
  • National University Hospital
  • Ng Teng Fong General Hospital
  • Alexandra Hospital
  • Jurong Community Hospital
  • National University Polyclinics
  • Jurong Medical Centre
  • National University Cancer Institute, Singapore
  • National University Heart Centre, Singapore
  • National University Centre for Oral Health, Singapore
  • NUHS Diagnostics
  • NUHS Pharmacy
  • Yong Loo Lin School of Medicine
  • Faculty of Dentistry
  • Saw Swee Hock School of Public Health
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