Pediatric Cardiology

Heart Palpitations in Children: Symptoms, Causes and Treatment Options

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

Palpitations in children refer to the heart beating much faster than normal, irregularly, forcefully, or with a sensation of skipped beats while at rest or during physical activity. This rhythm change, which is extremely concerning for parents, usually occurs as a temporary physiological response of the body to environmental factors or everyday sources of stress. However, this intense sensation of the heartbeat may sometimes be the first sign of an important problem in the heart’s electrical conduction network or structural anatomy. Identifying the underlying cause of this condition, which creates significant discomfort in the child’s chest, is the most fundamental step in safeguarding pediatric heart health.

Why Are Palpitations in Children Evaluated Differently From Those in Adults?

The heart structure, vascular system, and functioning mechanisms of children’s and infants’ bodies are based on a different foundation from those of an adult. We can compare the heart to the electrical wiring of a house. The current originating from the main switch spreads to all rooms through cables and enables the heart to contract regularly and rhythmically to pump blood throughout the body. In children, this electrical conduction network and the autonomic nervous system are still in the process of development and maturation as they grow. Therefore, the speed and rhythm of a child’s heart vary greatly depending on the developmental stage, age, current state of sleep or wakefulness, body temperature, and hormonal fluctuations throughout the day.

The limits considered concerning in adult medicine do not apply in the same way to children. While a heart rate above one hundred beats per minute in adults is called tachycardia, meaning a rapid heartbeat, this threshold cannot be used directly as an indicator of disease in children. The heart rate gradually slows and stabilizes as the child grows. The normal heart rate of a newborn baby in the first month of life may range between ninety and one hundred eighty-two beats per minute. In infants between one and three months of age, this range is between one hundred twenty and one hundred seventy-nine. In infants from six months to one year of age, the average rate decreases to one hundred thirty-one beats. When the child begins to walk, between one and three years of age, the normal heart rate range starts to decline to between seventy and one hundred ten. By school age, this rate gradually becomes slower. In adolescence, it slowly approaches adult values and settles between sixty and one hundred beats per minute.

In addition to all these physiological differences, it is entirely normal for the heart rate of healthy newborn babies to rise to as high as one hundred seventy beats per minute during crying episodes, hunger, or restlessness. Another important issue is respiratory-related rhythm fluctuations in children. The heart rate naturally increases while the child inhales and slows while the child exhales. This physiological fluctuation, which often leads families to bring their children to the hospital with concerns about an arrhythmia or skipped heartbeat, is an indication of the remarkable harmony between the heart and the nervous system and requires absolutely no medical intervention or treatment.

Does the Sensation of Palpitations Always Indicate Heart Disease?

One of the most common and reassuring findings in clinical evaluations is that the complaint of palpitations does not actually arise from a structural abnormality in the heart. A normal response of the heart to a problem elsewhere in the body or to an environmental factor may create a strong heartbeat sensation in the chest. When the body’s alarm system is activated, adrenaline is released from the adrenal glands, causing the heart to work faster and pump more blood throughout the body. Factors such as intense physical exercise, stress related to school examinations, excessive anxiety, fear, or dehydration due to insufficient fluid intake naturally accelerate the heart. This condition is called physiological acceleration.

Daily lifestyle habits and dietary patterns also play a major role in this process. Energy drinks consumed uncontrollably, especially by adolescents, and cold or hot coffee containing high amounts of caffeine may overstimulate the heart. Similarly, active ingredients contained in certain medications used during the winter months for colds, influenza, or asthma treatment may stimulate the heart’s electrical system and directly trigger the sensation of palpitations.

Common non-cardiac causes of palpitations include:

  • High fever
  • Anemia
  • Hyperthyroidism
  • Fluid loss
  • Stress
  • Anxiety
  • Fear
  • Caffeine
  • Energy drinks
  • Chocolate
  • Panic attack

Of course, this sensation is not always based on such harmless causes. Rhythm disorders that develop due to structural heart diseases also exist. Congenital defects between the atria or ventricles, structural prolapse of a heart valve, or vascular anomalies may mechanically stretch the heart’s electrical system and lead to dangerous short circuits. In addition, even in children with no structural heart abnormality, very serious episodes of palpitations may occur due to an extra electrical pathway present from birth or electrical channel disorders at the cellular level.

What Are the Symptoms of Palpitations in Different Age Groups?

The way palpitations present and the way the patient expresses them change dramatically with age. Detecting the problem in infants who cannot yet speak or describe what they feel requires very careful observation. In small infants, rhythm disorders reveal themselves through certain clues that fall outside the family’s usual daily routine. Infants’ hearts are highly resistant to very rapid rhythm attacks and may tolerate them for up to twenty-four hours. However, if this period is exceeded and the rapid rhythm cannot be stopped, the heart’s pumping power becomes exhausted, insufficient oxygen reaches the tissues, and a severe condition called heart failure begins to develop. For this reason, recognizing changes in infants quickly is vital.

Common symptoms of palpitations in infants include:

  • Restlessness
  • Crying
  • Paleness
  • Bluish discoloration
  • Tachypnea
  • Loss of appetite
  • Weakness
  • Sweating

Older school-age children and adolescents who can express themselves may describe their experience to their doctors very clearly. They may say that it feels as though a bird is fluttering inside their chest, that their heart is pounding so hard it feels as though it will come out, or that they feel a pulse in their throat. In some cases, these complaints may be accompanied by the need to breathe deeply during exercise, becoming tired much more quickly than peers, and a feeling of weakness. The most important clinical clue for distinguishing simple heart rate acceleration from a true rhythm disorder is the way the episode starts and ends. In true arrhythmias, the palpitations do not accelerate gradually; they begin suddenly, as if an electrical switch has been turned on, and stop just as suddenly within seconds.

Common symptoms of palpitations in older children include:

  • Chest pain
  • Shortness of breath
  • Darkening of vision
  • Fainting
  • Fatigue
  • Palpitations
  • Dizziness

Since young children may not recognize palpitations, they may describe the sensation as chest pain. For this reason, obtaining a detailed medical history is important.

Which Modern Methods Are Used to Diagnose Palpitations?

The evaluation of a child brought to the clinic with complaints begins with an extremely detailed medical history obtained from the family and a careful examination. Most murmurs heard while listening to the child’s heart with a stethoscope are innocent and harmless. However, if pathological murmurs suggesting a structural heart problem are suspected, confirmation must be performed with an echocardiography device that displays the internal structure of the heart using ultrasound waves. Especially in young children, manual examination of the pulses in the groin and measurement of blood pressure in all four limbs are medical necessities to determine whether there is narrowing of the aorta.

After the examination, an electrocardiogram is performed to record the electrical map of the heart on paper. ECG provides vital information about the heart rate, electrical axis, conduction problems, and possible thickening of the heart muscle. However, there is a major limitation: ECG shows only the brief ten-second period during which it is recorded. In rhythm disorders that begin and disappear suddenly, the palpitation episode may already have ended by the time the patient reaches the hospital and is connected to the device, so the ECG may appear completely normal.

At this point, rhythm Holter monitoring comes into use. A Holter device consists of small wires attached to the child’s body and a small recording device worn at the waist. While the child continues normal daily life, sleeps, plays, or goes to school, every heartbeat is recorded digitally for twenty-four hours. The family is asked to write down the moments when the child experiences symptoms in a diary. In this way, the time of the complaint written in the diary is matched with the ECG recording at that exact second, allowing the source of the problem to be identified clearly. Numerous types of arrhythmias that may be missed during a standard examination can be successfully detected with a Holter device.

If palpitation episodes occur very rarely, for example only once a month, twenty-four-hour Holter recordings may also be insufficient. In this case, devices that provide longer-term monitoring are needed.

The main diagnostic devices used are as follows:

  • Echocardiography (ECHO)
  • Electrocardiography (ECG)
  • Holter monitor
  • Event recorder
  • Implantable loop recorder (ILR)
  • Exercise stress test (Treadmill test)

Event recorders are devices that can remain on the patient for up to one month and record when the button is pressed during symptoms. Implantable loop recorders are revolutionary miniature devices placed under the skin over the chest muscle through a small incision and can continuously record every moment of the heart for up to three years. The exercise test allows symptoms that occur especially during sports or running to be triggered and examined under controlled laboratory conditions.

Which Symptoms Are Dangerous in Cases of Palpitations and Fainting?

According to medical science, fainting is a brief loss of consciousness and posture caused by a temporary reduction in blood flow to the brain. Although most fainting episodes seen during childhood appear frightening, they are actually based on a harmless cause. This benign condition, called vasovagal syncope, may be triggered by seeing blood, fear of vaccination, excessive excitement, standing motionless for a very long time, hot and poorly ventilated environments, or dehydration. The brain activates the fainting reflex to bring the body into a horizontal position and protect itself against these stress factors. This condition can usually be easily controlled by increasing the child’s daily water intake and balancing salt consumption.

However, the cardiac causes of fainting are extremely serious, life-threatening, and require immediate medical intervention. Cardiac fainting may result from severe narrowing of the aortic valve, genetically caused excessive thickening of the heart muscle, inflammation of the heart muscle, or extremely rapid and fatal rhythm disorders. Especially in young athletes engaged in active sports, sudden deaths occurring despite the apparent absence of disease are generally caused by genetic abnormalities in the heart’s electrical channels. There are red flag signs that require families and coaches not to consider the event a simple fainting episode and to seek advanced evaluation immediately.

Red flag findings that must be investigated include:

  • Exertion
  • Exercise
  • Seizure
  • Convulsions
  • Injury
  • Chest pressure

A child suddenly losing consciousness while playing football, swimming, or running during exertion is never normal and must be evaluated immediately with an exercise test. If the family tree includes a history of unexplained sudden death in individuals under the age of fifty, it is mandatory to investigate the child for genetic rhythm disorders. In innocent fainting, vision gradually darkens, the patient realizes that fainting is about to occur, and slowly collapses to the ground. However, in cardiac fainting, consciousness is lost instantly, and because blood does not reach the brain, the patient falls face-first without even showing the protective reflex of extending the hands forward. This situation is a clear warning sign of a dangerous rhythm problem.

What Can Be Done During Palpitation Attacks That Begin Suddenly at Home?

If your child suddenly develops palpitations while sitting calmly or resting at home, without fever, infection, or an obvious source of stress, and the heart is beating so rapidly that it can be seen from the outside, there are certain first-aid steps that can be performed without panicking. If the child is conscious, there is no bluish discoloration of the lips, and breathing is regular, special physical interventions called vagal maneuvers may be applied to stop the rhythm disorder without medication until the hospital is reached. The purpose of these maneuvers is to stimulate the vagus nerve, the main switch of the parasympathetic nervous system, and send a strong signal to the heart to slow down suddenly. The vagus nerve passes through the neck to the heart and functions like the body’s brake pedal.

In infants and children under three years of age, an remarkable natural physiological mechanism called the diving reflex is used to stimulate the vagus nerve. When the human face suddenly comes into contact with very cold water, the brain assumes that the body has gone underwater and immediately slows the heart to conserve oxygen. In the past, applying ice to the face was used in young children, but this is now avoided. Instead, as a second option, the gagging or vomiting reflex may be triggered by gently touching the base of the baby’s tongue with the tip of a clean spoon.

The situation is different in older children and adolescents because they can follow instructions.

Vagal maneuvers that may be performed in older children include:

  • Bearing down
  • Coughing
  • Cold water
  • Ice
  • Standing on the hands

The most effective method is the Valsalva maneuver. The child is instructed to take a deep breath, hold it, and bear down forcefully for thirty seconds as if straining during a bowel movement or blowing up a balloon. The sudden increase in abdominal pressure strongly stimulates the vagus nerve. Alternatively, washing the face with ice-cold water, drinking a full glass of very cold water, coughing repeatedly in a controlled manner, or raising the legs while keeping the head lower may help stop the rapid rhythm at home. If the palpitations continue despite all these measures, a fully equipped healthcare institution should be visited without delay.

Which Treatments Are Applied for Acute Palpitation Attacks in the Hospital?

In palpitation attacks that do not respond to physical vagal maneuvers and continue persistently, a prolonged ECG recording is obtained in the emergency department, and urgent medical treatment is initiated according to the patient’s general condition. The most common type of rhythm disorder in children is supraventricular tachycardia originating from the atrial region of the heart. In this condition, the main strategy is to suddenly slow conduction through the atrioventricular node, which is the electrical gateway between the upper and lower parts of the heart. The gold-standard medication in the emergency treatment of rapid rhythms caused by short circuits is a substance called adenosine.

Adenosine is administered directly into the bloodstream very rapidly through an intravenous line. In the first second when the medication reaches the heart’s electrical system, it temporarily and completely blocks the abnormal short circuit in the heart. Much like turning off and restarting a frozen computer, it allows the heart’s natural pacemaker to regain control. During the brief second in which the medication is administered, a temporary pause, a significant slowing of the heart rate, or even a flat line may be observed on the patient’s cardiac monitor. This is a natural result of the medication’s mechanism of action and is an expected and entirely normal process for physicians. If the first dose is insufficient, the procedure is repeated a few minutes later with an increased dose.

However, in some cases there is no time to wait for medication treatment. If the child’s heart is beating so rapidly that blood flow to the body and brain is severely impaired, blood pressure has fallen to very low levels, and shock has begun to develop, emergency electrical cardioversion, meaning the delivery of a shock, becomes a vital necessity. After the child is given light anesthesia to prevent pain, a controlled and synchronized electrical shock is delivered through the chest using a special medical device. This procedure resets the heart’s complex and potentially fatal rapid electrical activity within fractions of a second and definitively restores a normal and healthy rhythm.

What Is Catheter Ablation in the Treatment of Palpitations and How Is It Performed?

Treatments using medications generally work only to stop the current palpitation episode or reduce the frequency of attacks. However, electrophysiological study and catheter ablation methods are used to completely eliminate the extra electrical pathway or the cellular focus producing abnormal signals inside the heart and to free the patient from taking pills every day for life. When a clear diagnosis cannot be made with external tests such as a twenty-four-hour rhythm Holter monitor and ECG, or when a rhythm disorder requiring definitive treatment is detected, an electrophysiological study is performed as a highly precise and advanced interventional procedure in a laboratory environment.

This procedure generally begins by putting the patient to sleep or providing deep sedation. Very soft and flexible technological wires, called catheters, as thin as spaghetti are inserted through the large veins in the child’s groin. These thin wires follow the vascular pathway and are advanced directly into the chambers of the heart. The conductive parts at the tips of the catheters contact the inner surface of the heart and create a millimetric electrical map of the heart. Once the exact location and millimeter point of the short circuit causing the problem is identified, ablation treatment, meaning the therapeutic stage, begins.

Today, two main energy sources are used to perform this procedure. The first is radiofrequency ablation. High-frequency radio waves are delivered through the tip of the catheter, burning the abnormal tissue with high heat and permanently destroying that small cellular point. The second is the freezing method called cryoablation. In this system, the focus causing the palpitations is frozen at temperatures reaching minus eighty degrees, terminating its function. Cryoablation is preferred especially for short circuits located in highly risky and sensitive regions very close to the heart’s main electrical pathways. The reason is that it is highly safe; if undesirable slowing of the heart develops during freezing, the tissue can immediately be rewarmed and the process reversed without permanent damage. The success rates of the procedure are above ninety percent.

Is Treatment of Palpitations With Zero Radiation Possible?

In previous years, during electrophysiological studies and ablation procedures performed with traditional methods, physicians used continuous X-ray imaging to guide the thin catheters inside the heart and determine their location. This requirement meant that the child was exposed to a significant amount of medical radiation throughout the procedure. Since cell division is very rapid in growing children, their DNA structures and tissues are much more vulnerable and fragile than those of adults to the harmful, cell-damaging, and cancer-causing effects of radiation.

However, with a new and advanced technology used in modern pediatric cardiology centers, radiation exposure has now become a thing of the past for pediatric patients. Thanks to three-dimensional anatomical mapping systems, a three-dimensional, moving, and electrical model of the heart is created digitally on a computer screen, much like virtual reality, through special patches attached to the chest and back. This advanced navigation system identifies the source of the problem inside the heart with millimetric precision. The physician performs the procedure with exceptional safety by following the catheters entirely through the three-dimensional heart model on the computer without activating the radiation-emitting X-ray device even once.

This is called zero-radiation ablation. The child is treated entirely with digital systems without receiving a single dose of radiation. After this procedure, which generally lasts a few hours, the child rests in the room, gets up the next morning, is discharged from the hospital, and can return to school, play, and normal daily life within a few days. All rhythm-regulating medications previously used by the child are completely discontinued, allowing the child to take a step toward a healthy future.

When Can a Child Return to Sports After Palpitations and Inflammation of the Heart Muscle?

When unexplained chest pain, the need for deep and rapid breathing, extreme exhaustion, and a very rapid heartbeat even at rest occur together in children, inflammation of the heart membrane and heart muscle must be considered. If the disease affects the inner heart muscle more severely, it is called myocarditis; if it affects the outer membrane more severely, it is called pericarditis; and if both are involved, it is called myopericarditis. It is an extremely serious condition that generally develops when viruses causing upper respiratory tract infections, severe influenza-like illnesses, or intestinal infections spread to the heart through the bloodstream.

During diagnosis, elevated cardiac enzymes in the blood, widespread abnormalities seen on ECG, and detection of reduced contraction strength of the heart on cardiac ultrasound confirm the diagnosis. In treatment, special anti-inflammatory medications and a specific agent called colchicine are used within a long-term protocol lasting for months to suppress the inflammatory reaction in the heart membrane and muscle. Throughout the treatment process, resting the heart is vitally important for complete resolution of the inflammation.

The most critical issue is restricting the child’s physical activity. It is an indisputable medical necessity for athletic children and active adolescents who have had this disease to stay completely away from strenuous physical activity for at least six months to prevent a sudden and fatal rhythm disorder attack while the body is still healing. At the end of the six-month rest period, certain approvals must be obtained before safely returning to sports.

The conditions required for returning to sports are as follows:

  • Normal ECG
  • A normal twenty-four-hour rhythm Holter result
  • Echocardiographic findings within normal limits
  • An exercise test without arrhythmia
  • Cardiac enzymes detected within the normal range

Frequently Asked Questions

Palpitations are a condition in which a child feels the heartbeat as faster, stronger, or more irregular than normal. They may be described as fluttering in the chest, rapid pounding, or skipped beats.
Fever, stress, anxiety, intense exercise, anemia, caffeinated beverages, and certain rhythm disorders may cause palpitations in children. Although most causes are benign, evaluation may be necessary.
Palpitations may be accompanied by dizziness, shortness of breath, chest pain, weakness, sweating, or fainting. If these symptoms are present, a detailed examination should be performed for underlying heart disease.
No, not every palpitation means heart disease. Temporary palpitations may occur especially during stress, excitement, or fever. However, frequently recurring attacks require specialist evaluation.
Physical examination, electrocardiography (ECG), Holter rhythm monitoring, and echocardiography when necessary may be used in diagnosis. These tests help determine the cause of the palpitations and possible rhythm disorders.
Symptoms such as palpitations, dizziness, or fainting that develop during exercise should be taken seriously. In this situation, the activity should be stopped, and a pediatric cardiology specialist should be consulted.
Treatment is planned according to the cause of the palpitations. While monitoring alone may be sufficient for some children, medication treatment or advanced interventional methods may be required in patients with a detected rhythm disorder.
Yes, certain rhythm disorders may temporarily affect the heart’s ability to pump blood. This may lead to dizziness and, rarely, fainting episodes.
Regular sleep, adequate fluid intake, reducing stress, and avoiding products containing caffeine may help reduce complaints of palpitations in some children.
A Pediatric Cardiology specialist should be consulted for palpitations that recur frequently or occur together with other symptoms. Early evaluation is important for diagnosing possible rhythm disorders.
Güncellenme Tarihi: 13.10.2026

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