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.
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.