Patient
Information
Growth Problems in Children with Congenital
Heart Disease
One topic that frequently comes up among
children with congenital heart disease is that of the child who is
small or “petite” compared to other children their age. There are
several issues that relate to this:
1. Many children with congenital heart
disease, even mild congenital heart disease such as atrial septal
defects or small ventricular septal defects, seem to be
constitutionally smaller than other children. In other words, their
natural programming is just to be petite. Such children tend to be
on the small side for both height and weight, and no amount of extra
feeding is likely to have much effect. If other causes of small
size have been eliminated, it is helpful to understand this so that
families can stop kicking themselves trying to make children grow
faster by pressuring them to eat more. To be comfortable with this,
however, we have to be sure about three additional points.
2. Some children with certain types of
congenital heart disease, including atrial septal defects, tend to
smaller than other children, and particularly seem to be skinny, or
have low weight relative to their height. Most of these children
have some improved growth if the heart disease is corrected with
surgery or a catheter procedure.
3. There are some hormone problems that can
cause poor growth in children. Such problems are uncommon but often
treatable. If it seems unlikely that a child has the sort of
congenital heart disease that would cause poor growth, sometimes it
is appropriate for a family to see a pediatric endocrinologist to
rule that out before they spend much time talking about surgical or
catheter correction of congenital heart disease.
4. There are many other reasons to be small as
well, including problems with absorbing nutrients, certain
infections, genetic problems and so forth. These issues need to be
considered as well, generally with the family’s primary care
physician.
It
generally makes sense to march through the four issues backward,
starting with the primary care physician to make sure the common
problems have been considered, then deciding whether a visit with an
endocrinologist would be in order. If that is all unrevealing, it
makes sense to consider whether repair of congenital heart disease
makes sense even if there are not other strong reasons to consider
doing so.
Reading More:
There are not any good web sites I have found on this topic, but
there is a reasonably good summary in the article listed below:
Impact of anatomic closure on somatic growth among small,
asymptomatic children with secundum atrial septal defect.
Rhee EK, Evangelista JK, Nigrin DJ, Erickson LC.
Am J Cardiol. 2000 Jun 15;85(12):1472-5.
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