Doc, My Kid's Heart Is Beating Out His Chest!

This week's guest columnist is Dr. Danielle Duhon, a family practice resident at the University Hospital and Clinics here in Lafayette. First the child complains of chest pain.  She might even say it in scarier terms: "My heart hurts."  Then mom puts a hand on daughter's chest- mom can feel her heart beating!   Maybe Uncle Joe just died of heart disease.  Now it's panic time! Chest pain and palpitations are scary things.  Adults think about heart problems and assume the worst.  After all, we have been told over and over: if you have chest pain, get seen, it could be a heart attack.  In kids however, chest pain is rarely the heart- it's usually strains in the chest wall- ribs, cartilege, and muscle. Sometimes it's heart burn or occasionally lung issues. But what about palpitations- that feeling of heart pounding?  Your child complains, you feel their chest, and you're certain the heart is going to jump right out!  Before you lose your cool, try to think.  Lots of things can cause your child's heart to race: recent activity, caffeine, or many medicines.  If your child has been running around or doing other high-energy exercise, have them rest for a moment.  See if it slows down. Consider other causes of a pounding heart.  Caffeine can ramp up your child's heart rate. Soda, coffee, and especially energy drinks all contain caffeine and other stimulants. The extra ingredients that give energy drinks their "boost," like guanara, can be more stimulating than caffeine and make the heart race like crazy.  Now there are "energy" candies, gum, gels, and water mix-ins.  With all that stimulant coursing through your veins, it's no wonder your heart is going BA-DUM, BA-DUM! There are several medications that can push the heart. Even if your kid is adult-sized, children metabolize medications differently than adults. Always read the bottle or talk to your doctor to make sure the medication and dose are safe.  Examples of medications that can stimulate the heart include antihistamines (benadryl, chlorpheniramine, hydroxyzine, zyrtec, claritin, allegra), decongestants (pseudophedrine, phenylephrine), and cough suppressants (dextromethorphan). Besides caffeine and over-the-counter medications, your child could be prescribed a medication that can cause palpitations.  These include stimulants to treat ADHD or inhalers for asthma.  If a kid combines those medications with other stimulating medications or caffeinated drinks, he is getting double duty and can certainly have a pounding heart. Unfortunately some teenagers smoke cigarettes (real or electronic) or use chewing tobacco.  These contain nicotine, which is a stimulant.  Used alone or in combination with medications, caffeinated or "energy" drinks, and/or prescriptions, nicotine will certainly get some teenagers' hearts going overtime. Finally, anxiety is a common cause of palpitations.  Some kids are worriers.  Kids have lots to worry about.  There is pressure to do well in school.  There can be family strife like parental fighting and divorce, bullying siblings, or loss of a loved one through moving or death.  There are social worries: am I too fat/ugly/stupid/boring/etc? Some kids also worry about the big questions: Will the world end?  What is the meaning of life?  Does the little red-haired girl like me? Some kids live with worry so much they internalize it and don't realize that worries are the cause of their pounding heart.  Sometimes we ask the child what is worrying them and they can't say because they are so used to the worry that they don't realize it IS a worry. Or they are afraid to talk about it in front of a parent.  This is where counseling can be helpful so the child can explore and diffuse the anxiety. Now don't hesitate to call your doctor if your child is having a pounding heart with dizziness, fainting spells, or breathlessness.  There are medical conditions that need be checked.  If you can't talk to your doctor and are concerned, you can go to the Emergency Department. But perhaps you can think back and figure it out before you get to that point. Kids have strong hearts, so strong that even though it's probably not a heart problem, it feels like its going to beat right out of his chest!