Do you know how to read the electrocardiogram (ECG) of a 6-day, 6-month or 6-year-old child?
Do you have equipment to defibrillate or shock a 6-month-old patient?
Do you know the name and contact number of the closest pediatric cardiologist or referral center?
Background and Basics:
- Pediatric cardiac emergencies are very different from adults, and pediatric ECGs are performed in a small percentage of EMS transports and ED visits for children
- A significant proportion of pediatric ECGs are performed in adolescents or for chief complaints of chest pain and syncope
- Infants and younger children tend to have ECGs performed for evaluation of suspected congenital heart disease, ingestions, altered mental status and dysrhythmias.
- In infants and young children, try to decrease movement and ECG artifact by:
- allowing a parent or caregiver to hold them (if possible) or lie beside them
- allowing the child to take a bottle, use a pacifier, or a sucrose containing solution
- using distraction techniques such as music, lighted toy, movie
Key pediatric ECG indications include:
- Known cardiac history or familial history of sudden cardiac death
- Cyanosis and or apnea
- Newborns and infants presenting with irritability, tachypnea, poor feeding, or failure to thrive.
- Loss of consciousness
- Drug ingestion or other poisoning
- Dysrhythmia
- Chest pain on exertion
- Suspected Kawasaki’s disease
Interpretation of pediatric ECGs must account for age. Normal values for things like the QRS axis vary significantly from adults. Many differences are due to the right ventricular dominance in infants, and the evolution to adult dynamics.
There is no way to memorize all pediatric cardiology and ECG values. The rest of this PEARL will focus on pediatric ECG basics and resources.
