Palpitations in Children

Palpitations refer to an uncomfortable awareness of one's own heartbeat, described by children and adolescents in various ways, including a racing, fluttering, pounding, or skipping sensation in the chest, throat, or neck. The sensation may last a few seconds or persist for minutes to hours, and it may begin and end gradually or start and stop very abruptly.

Palpitations are a common complaint in childhood and adolescence, and the great majority of the time they reflect a benign, non-dangerous cause rather than a serious heart problem. That said, palpitations are a symptom rather than a diagnosis in themselves, and a small proportion of cases do reflect an underlying arrhythmia or structural heart condition, which is why a careful description of exactly what the sensation feels like, how it starts and stops, and what else is happening at the time is such an important part of sorting out the underlying cause.

• Physiological triggers — the most common causes of palpitations in children are physiological rather than related to heart disease, including a normal increase in heart rate during exercise, fever, strong emotion, or anxiety, all of which can make a child suddenly and uncomfortably aware of their own heartbeat even though nothing is wrong with the heart itself
  
  
• Premature contractions — extra or skipped-feeling beats, caused by premature contractions that briefly disrupt the heart's regular rhythm; common and generally considered benign, particularly when they occur in a structurally normal heart and disappear during exercise
  
  
• Stimulants — certain substances, including caffeine and some over-the-counter or stimulant medications, can also trigger a noticeable increase in heart rate that a child may describe as palpitations
  
  
• True arrhythmia — a smaller but important group of cases reflects an actual arrhythmia, such as supraventricular tachycardia, which characteristically causes a very sudden, distinct start and stop to a fast heartbeat rather than a gradual change
  
  
• Elevated risk factors — palpitations are more likely to reflect a significant underlying cause in children who have a personal history of congenital heart disease, prior heart surgery, cardiomyopathy, or a previously identified abnormal heart rhythm, or a family history of sudden unexplained death, inherited arrhythmia syndromes, or unexplained fainting

• Routine evaluation by a pediatrician is reasonable for palpitations that occur occasionally, resolve quickly on their own, and are not accompanied by other concerning symptoms, since this pattern is typically benign; the physician can determine through history, examination, and often a simple electrocardiogram whether further cardiology evaluation is warranted
  
  
• More urgent evaluation is needed when palpitations are accompanied by chest pain, dizziness, fainting, or significant shortness of breath, since this combination raises the likelihood of a true arrhythmia requiring prompt assessment
  
  
• Palpitations that begin and end very suddenly, that occur during exercise, or that happen in a child with a known history of congenital heart disease, prior heart surgery, cardiomyopathy, or a family history of inherited heart rhythm conditions or unexplained sudden death should also be evaluated by a pediatric cardiologist rather than managed through routine primary care alone

Because an arrhythmia is often intermittent and may not be captured during a brief clinic visit, extended heart rhythm monitoring over a day or longer is frequently used when the history raises genuine concern, even if an initial electrocardiogram appears normal.