Pulse Rate In Children– An Overview

The heart has a particular rhythm that keeps it healthy and enables it to function the way it is meant. However sometimes due to various reasons, the rhythm of the heart or the rate of heartbeat varies, which may indicate an underlying issue. While it is not uncommon to see the heartbeat rate fluctuate in children, if it persists for a long duration, then your child may need medical attention.

What is Normal Heart Rate in Children

The normal pulse rate for children varies as per their age. It is also known to slow down a little during sleep. Heart rate is also dependent on the activity of the kid. If your child has been physically active right before taking pulse rate then it is bound to be a little higher. Overall health and emotional state of the child may also contribute to the pulse rate of your child.

Below is a chart of normal heart rate for kids of various ages:

Age	Rate while awake (beat per minute)	Rate while sleeping (beat per minute)
under 28 days	100-205	90-160
1 month to 1 year	100-190	90-160
1 to 2 years	98-140	80-120
3 to 5 years	80-120	65-100
6 to11 years	75-118	58-90
12-15 years	60-100	50-90

What is Arrhythmia?

Arrhythmia is an irregularity in the rhythm of the heart. It is caused due to an abnormality of the electrical signals that control contractions of the heart muscles. The occurrence of certain kinds of arrhythmia in children is usually no cause for concern and may not require medical care.

A change in heart rate is normal in children based on the activity they engage in. But if it is found that the heart rate of the child doesn’t correlate with the activity and is too high or too low for the activity being performed, then it may be wise to seek a diagnosis from a doctor.

Who is at a Risk of Developing Arrhythmia?

An arrhythmia may be prevalent in children who are suffering from congenital heart diseases, are born with narrow hearts or any other heart conditions. Infections, diabetes and sleep apnea can cause damage to the muscles around the heart which may also put such kids at a risk of developing an arrhythmia. Also, if your kid has had heart surgeries, is under medication or suffers from a chemical imbalance, then there may be chances of an irregular heart rate.

Types of Arrhythmia

Arrhythmia is categorized based on the variation in the heart rate. There are many types of arrhythmia,  most are harmless, however, some may be life-threatening.

If the heart rate speeds up and becomes too fast it is known as Tachycardia. If it slows down considerably it is called Bradycardia. Both conditions are explained in detail below:

1. Tachycardia

Tachycardia is characterized by a faster than normal heart rate and may be caused due to an underlying heart condition, medications or some changes in the physiology. It doesn’t last long enough to cause any serious damage to the organs. There are two significant types of tachycardia.

• Ventricular Tachycardia

Ventricular tachycardia originates in the ventricles or the lower chambers of the heart. These are not very common in children and might be the result of a serious heart condition.

• Supraventricular Tachycardia(SVT)

Supraventricular tachycardia is triggered in both the upper(atria) and lower(ventricles) chambers of the heart. SVT causes the heart rate to go at an abnormal rate of over 220 per minute. It is also known as paroxysmal atrial tachycardia and begins and ends abruptly.

SVT may be caused due to Wolff-Parkinson-White Syndrome, where there is an extra pathway in the heart electrical system, which can result in tremors, dizziness, and problem breathing.

There are several types of SVT which include:

• Atrioventricular Reentry Tachycardia(AVRT)

Caused due to the presence of an additional pathway because of which the electrical signals do not pass through the AV node that controls heart rate. The heart rate increases as two pathways carry electrical signals at the same time.

• Atrioventricular Nodal Reentry Tachycardia(AVNRT)

This condition is similar to AVRT, but the electrical signals here pass through the AV node.

• Atrial Flutter

The condition is the result of an irregular conduction circuit in the atria causing it to beat very fast. This can prevent blood from being pushed into the ventricles and prevent blood flow to the body cells.

• Atrial Ectopic Tachycardia

Caused as a result of the electrical impulse being originated from a different part(an abnormal cluster of cells) than its usual origin (sinus node), it can result in the untimely contraction of the atrium and a faster heartbeat.

• Junctional Ectopic Tachycardia

In this case, the impulse originates from the abnormal cluster of cells that are located near the AV node causing the ventricles to contract before they are due. This results in a faster heartbeat.

There is also a term called Sinus tachycardia which is a natural increase in the heart rate caused by physical activity or change in activity levels. Here the sinus node, which is known as the pacemaker of the heart due to its function of generating electrical impulses, shoots out faster impulses causing a spike in the heart rate.

2. Bradycardia

Bradycardia characterized by a drastic drop in the heart rate of the child, in most cases, below 50 beats per minute. This can be due to faulty electrical circuits or can indicate that the sinus node isn’t functioning in the supposed manner. In some cases, since the heart rate drops quite low, the heart will not be able to pump blood into the cells causing a deficiency that may result in life-threatening situations.

Causes of an Irregular Heartbeat

Irregular heartbeat is caused by various reasons including heart conditions like congenital heart disease, chemical imbalances in the body, any kind of trauma to the chest, heart surgery, fever or infections. It can also be due to cardiomyopathy which is the disease of the muscles of the heart.

Signs and Symptoms of an Abnormal Heart Rate

Recognizing the signs and symptoms of an abnormal heart rate is important, especially for younger children who will not be able to communicate what they feel. Amongst infants and toddlers, it may be visible as irritability, paleness, and lack of interest in eating. Older children may be able to tell you if they feel dizzy or feel like their heart has skipped a beat. Some of the common symptoms of an irregular pulse rate are

• Dizziness
• Weakness or fatigue
• Tremors
• Chest pain
• Fainting
• Sweating
• Irritability and paleness in infants
• Shortness of breath

Diagnosis

Doctors use various methods to diagnose an abnormality in the heart rate of the child. It is important that you provide the doctor with your child’s medical history so that the doctor can evaluate it and conduct a physical exam to determine whether a further test is necessary.

Some of the tests that the doctor may perform include:

Electrocardiogram(ECG)

This test measures the electrical activity of your child’s heart. It is painless and can be done in as a resting ECG or an exercise ECG. A resting ECG measures the heart when your child is resting, preferably lying down. An exercise ECG measures the child’s heart rate during an activity like walking or running on a treadmill.

Holter Monitor

This is an ECG test that is done over a period of 24 hours or more. The ECG electrodes and attached to the chest of the child and the measurements are taken using a portable recorder. The child is encouraged to engage in normal daily activities. Care should be taken to keep the electrodes from getting wet for the duration of the test.

Holter monitoring includes two kinds of test

• Continuous monitoring where the ECG is being recorded for the entire duration.
• Event monitoring where the ECG is recorded when an abnormal heart rate is detected.

Electrophysiology Study

In this invasive test, a catheter is inserted into the blood vessel of the child that leads to the heart through the arms or the legs. This helps to determine the origin of arrhythmia in the heart and choose relevant treatments methods.

Tilt Table Test

Tilt table test is recommended for children who have instances of fainting that is caused by irregular heart rate. The test measures the variations in heart rate, oxygen supply, and blood pressure in the child during a change in his or her position, like sitting, lying down and standing.

Some doctors may also suggest a chest X-ray, MRI or blood tests for your child if required.

Treatment

The treatment for arrhythmia is based on the age of the child, the type of arrhythmia, the symptoms experienced and the frequency of its occurrence. Some of the common courses of treatment include

• Medicines: Anti-arrhythmic medications are prescribed to the child based on the condition and the age to correct an abnormal heart rate.

• Pacemakers: These devices that mimic the electrical signals produced by the sinus node and implanted into the child’s body to regulate heart rate effectively. They are surgically implanted, usually near the collarbone.

• Defibrillator: An implantable cardioverter defibrillator (ICD), is inserted near the collarbone with wired running from it to the heart. When an abnormal heart rate is detected, the device restores it to a normal heart rate.

• Catheter Ablation: The procedure involves the insertion of a catheter through a blood vessel in the leg or the arm that leads to the heart. It detects and narrows down the area of the heart where the irregularity is generated and freezes or destroys those defective cells.

• Surgery: If all other options do not give results, a surgery is recommended where the child is put under anaesthesia and the tissue causing the arrhythmia is surgically removed.

When and How to Check your Child’s Pulse Rate?

It is good to have an idea of how to check your child’s pulse rate for emergencies. If your child has a heart condition, your doctor may already have instructed you on the ways to check the pulse. However, even if your child doesn’t have a heart condition, it is good to know how to check the pulse rate when your child has,

• Pain in the chest
• Tremors
• Turns pale of blue suddenly
• Shortness of breath

You may follow the steps below to check your child’s pulse rate

1. Know the pulse points: The points where the artery is closest to the skin like the neck and the wrist and the best pulse points.
2. Make sure that your child is rested for at least 10 minutes before taking the pulse rate.
3. Place your index and middle finger together on the pulse point at the wrist to feel the pulse.
4. Count the total number of beats for 15 seconds.
5. Multiply the total number of beats by 4 to get the pulse rate.

Avoid using your thumb to feel the pulse as the thumb also has a pulse point.

How to Take Care of your Child

If your child is diagnosed with arrhythmia it is important that you follow a strict routine to take care of his or her health.

1. Take your child to the doctor for check-ups regularly.
2. Check the pulse rate frequently.
3. Follow a healthy diet with low cholesterol and fat for a healthy heart
4. Ensure that your child exercises regularly to regulate heart rate.
5. Keep track of the developments in treatment for arrhythmia.

When to Consult a Doctor

Most children have irregular heart rate after intense physical activity. However, if you notice fast heart rate in your child that does not correlate with the activity, you will need to consult a doctor to avoid complications later on.

Children usually tend to engage in a lot of physical activity which may cause variations in the heart rate. It is important to be well informed about the symptoms to recognize when you need to seek help for irregular heart rate in your child.