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Heart Failure—Child

  • Cynthia M. Johnson, MA
Publication Type:


Heart Failure—Child


Heart failure is when the heart cannot work as well as it should. Problems caused by the failure will depend on the area of the heart that is affected. For example:

  • Right side heart failure—will slow blood flow to the lungs. Blood may also build up in the right side of the heart. This will lead to a backup of blood into the veins.
  • Left side heart failure—slows flow of blood out of the heart and to the body. Blood may also build up in the left side of the heart. It will then lead to a backup of blood into the lungs.

If fluid has backed up in the body or lungs it is called congestive heart failure. A person can also have failure on both sides of the heart. In time, the poor flow of blood will hurt other organs like the kidneys.

Blood Flow through the Heart.

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Heart failure in children is often caused by a problem with how blood moves through the heart. The heart muscle has to work harder than normal to make blood flow. This may be caused by birth defects, such as:

  • Holes in the wall of the heart
  • Leaky heart valves
  • Abnormal connections between blood vessels

Heart failure may also be caused by a problem with the heart itself. This is not common in children. This type of heart failure may be caused by:

  • Cardiomyopathy—enlargement of the heart muscle that makes it weaken and results in less room for blood to flow
  • Damage to the heart tissue from problems like:
    • A heart infection
    • Health issues, such as Kawasaki disease
    • Medicine, such as chemotherapy

In some children, the cause is not known.

Risk Factors

Things that may raise the risk of this problem are:

  • Problems with the structure of the heart or blood vessels
  • Recent bacterial or viral infection
  • Weak or damaged heart muscle
  • Taking certain medicines
  • Injury to the heart—this is rare


Problems can vary and can be mild to severe.

If blood is backing up in the right side of the heart, it can cause swelling in the feet, ankles, lower legs, belly, or eyelids. If blood is backing up in the left side of the heart, it can make it hard to breathe.

Other problems may be:

  • Fast breathing
  • Shortness of breath
  • Tiring easily
  • Needing rest breaks often during activity
  • Slowed or stopped growth
  • Nausea or vomiting
  • Sweating more than usual

Newborns may also have problems with feeding.


The doctor will ask about symptoms and health history. A physical will be done.

Blood and urine tests will be done to look for signs of heart failure.

The heart may be checked. This can be done with:

  • An ECG to check the electrical activity of the heart
  • Exercise stress test to see how the heart responds to physical demands
  • Echocardiogram to look at the heart and its structures
  • Chest x-ray to look for signs of fluid backing up in the lungs
  • Cardiac catheterization—a catheter passed to the heart to get images of blood vessels


The cause will need to be treated. It may stop or slow heart failure.

Supportive care may also be needed to manage health problems, such as:


There are no known guidelines to prevent this health problem.


Medicines can help by reducing how much the heart has to work. Options are:

  • A angiotensin-converting enzyme (ACE) inhibitors to widen blood vessels and decrease blood pressure
  • Digoxin to help the heart pump better
  • Beta-blockers to lower blood pressure and manage heartbeat
  • Diuretics to decrease swelling by removing excess fluid


Oxygen therapy may be used to raise the amount of oxygen in the body. Choices are:

  • Oxygen given through a mask or tube that fits under the nose
  • Extracorporeal membrane oxygenation (ECMO) to pass blood outside of the body into a machine. The machine works like the lungs and pushes oxygen into the blood. It can be used for a short time to give the heart and lungs a chance to rest. This may help the body recover from things like illness or infection.


Devices may be placed in the body to support the heart. Choices are:

  • A pacemaker to help control the rhythm of the heart
  • A left-ventricular assistive device (LVAD) to help the left side of the heart pump blood to the rest of the body until a heart transplant is available

A heart transplant may be needed if other methods do not help. This replaces a diseased heart with a healthy heart from a donor.





  • Heart failure in children and adolescents. American Heart Association website. Available at: http://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/heart-failure-in-children-and-adolescents.
  • Hsu D.T. and Pearson, G.D. Heart failure in children. Part I: History, etiology, and pathophysiology. Circulation: Heart failure, 2009; 2: 63-70.
  • Mechanical circulatory support for heart failure. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/mechanical-circulatory-support-for-heart-failure.
  • Cook, J.L., Colvin, M., et al. Recommendations for the use of mechanical circulatory support: ambulatory and community patient care: a scientific statement from the American Heart Association. Circulation, 2017; 135 (25): e1145-e1158.


  • Chelsea Skucek, MSN, BS, RNC-NIC
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.