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Technically, a heart murmur is simply a noise heard between the beats of the heart. When a doctor listens to the heart, she hears a sound something like lub-dub, lub-dub, lub-dub. Most often, the period between the lub and the dub, and the dub and the lub is silent. If there is any sound during this period, it is called a "murmur." Although the word is unsettling, murmurs are extremely common, and usually normal, occurrences.
In preschool and school-age children, heart murmurs almost always turn out to be harmless; the children require no special care, and the sound eventually disappears. These children have "normal" or so-called "functional" or "innocent" heart murmurs, caused simply by the way the blood is flowing through their hearts.
Diagnosing a Heart Murmur
If your child has a murmur, it probably will be discovered between the ages of 1 and 5 during a routine examination. The doctor will then listen carefully to determine if this is a "normal" heart murmur or one that might indicate a problem. Usually, just by listening to its sound and noting its location on the chest or back, the pediatrician will be able to tell into which group it falls. If necessary, she will consult a pediatric cardiologist to be certain, but additional tests are usually not necessary.
On rare occasions, a pediatrician will hear a murmur that sounds abnormal enough to indicate something more than just a noisy flow of blood through the heart. If the doctor suspects this, your child will be referred to a pediatric cardiologist for special tests that will enable a precise diagnosis to be made.
Heart murmurs that can be heard during the first six months of life usually are not functional or innocent, and they, too, require the attention of a pediatric cardiologist. Your infant will be observed for changes in skin color (turning blue) as well as breathing or feeding difficulties. He also may undergo additional tests, such as a chest X-ray, ECG and an echocardiogram. The echocardiogram creates a picture of the inside of the heart by using sound waves. If all of these tests prove normal, then it is safe to conclude that the baby probably has an innocent murmur, but the cardiologist and pediatrician will probably want to see him at frequent intervals to be absolutely certain.
Innocent heart murmurs require no treatment, nor should your child be excluded from sports or other physical activities because of one. The only people who need to know about such a heart murmur are the parents, the child and the doctor who examines him (this includes any physician who treats him in an emergency room or elsewhere). You don't need to tell school officials. They might misinterpret the information, thinking your child has a heart problem, and they could try to keep him from being physically active. For the same reason, when you complete health forms for school or camp, you should write "normal" in the heart section if your child's murmur is innocent. If there's a specific question about a heart murmur, write "normal" in the space provided.
Innocent heart murmurs, incidentally, generally disappear by mid-adolescence. We don't know why they go away, any more than we know why they appear in the first place. In the meantime, don't be discouraged if the murmur is softer on one visit to the pediatrician and loud again on the next. This may simply mean that your child's heart is beating at a slightly different rate each time. The murmur will most likely eventually go away.