The American Academy of Pediatrics (AAP) calls for all children to be screened for conditions that can lead to cardiac arrest or death. The recommendation applies to youth athletes as well as less active children and teens,
In a policy statement, AAP describes the screening—which consists of four questions—and offers new guidance to help pediatricians identify children at risk for heart-related problems as an update to 2012 recommendations. The statement, "Sudden Death in the Young: Information for the Primary Care Provider," focuses on preventing sudden cardiac arrest and sudden cardiac death and will be published in the July 2021 Pediatrics.
Beyond athletes
"We tended to focus on athletes in the past when parents brought their children and teens in for a
sports physical, or preparticipation exam," said Christopher C. Erickson, MD, FAAP, lead author of the statement. "We know today that all children and teens benefit from a simple screening to help identify any potential problem that warrants follow-up with a cardiac specialist."
The policy statement was developed by the AAP Section on Cardiology and Cardiac Surgery and the Pediatric and Congenital Electrophysiology Society (PACES) Task Force on Prevention of Sudden Death in the Young.
About 2,000 individuals younger than age 25 die each year of sudden cardiac death in the in the United States, excluding sudden infant deaths. While autopsy studies show that most patients had structural heart anomalies, the causes for 6%-40% of deaths remain unexplained.
The updated statement contains a comprehensive review of conditions that should prompt more attention and cardiology evaluation. It reviews four screening questions that are recommended, not just for athletes, but for all children.
"Ideally, this screening is incorporated into a child's regular exam at least every two to three years," said Jack C. Salerno, MD, an author of the statement. Ideally, these screening should start as they enter middle school or junior high school.
"The pediatrician is in an ideal position to check on a child's development into the teenage years and is aware of family history that may raise a red flag for potential heart related issues," Dr. Salerno said.
AAP recommendations
Pediatricians and other primary care providers should evaluate if a patient's clinical history, family history, and physical examination suggests a risk for sudden cardiac arrest or sudden cardiac death.
If there is a concern, an electrocardiogram should be the first test administered, and it should be interpreted by a physician trained to recognize electrical heart disease. The doctor should factor in a patient's clinical history and consider referral to a specialist.
Pediatricians should advocate for emergency action plans and CPR training within the community. The use of automated external defibrillators is effective, as well, in cases of sudden cardiac arrest.
The screening itself consists of four questions that ask if a child or teen has ever fainted or had an unexplained seizure or experienced chest pain or shortness of breath, as well as if family members have a history of cardiac conditions or death before age 50.
"No single screening strategy will detect every possible heart issue, and so it's important that we raise awareness and education not only in pediatric offices but within the community," Dr. Erickson said. "We encourage parents and pediatricians to be alert for any concerning signs or family history."
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