When Your Child Has Infective Endocarditis (IE)

IE can occur in any child but is not very common. The risk is increased if a child has certain heart problems. These include:

• An abnormal or damaged heart valve

• A problem heart valve that has been replaced with an artificial valve

• Certain congenital (present at birth) heart defects that have not been repaired, such as small defects between the lower chambers of the heart

• Repaired heart problems (for 6 months after surgery, or sometimes longer), such as residual defects between the lower chambers of the heart

• Previous endocarditis

• Significant infection in combination with any of the above. 

IE occurs when bacteria enter the bloodstream and become attached to the heart. A child with a heart problem is more likely to have areas in the heart that can get easily infected. The most common ways bacteria can enter the bloodstream are through certain dental and medical procedures. They can also enter the bloodstream through infections in other parts of the body, especially if not treated in a timely manner, or if your child has a weak immune system.

Symptoms of IE vary for each child. And many children may not have any specific symptoms. Symptoms can include:

• Rash

• Tiredness (fatigue)

• Weight loss

• Blood in the urine

• Joint pain or arthritis 

• Muscle aches and pain

• Heart palpitations

• Irritability

• Fevers that come and go

If IE is suspected, your child will likely be referred to a healthcare provider called a pediatric cardiologist. This is a doctor with special training to diagnose and treat heart problems in children. The healthcare provider will ask about your child’s health history and symptoms. The healthcare provider will also examine your child. Tests are often done as well. These can include:

• Blood tests and cultures.  Several blood samples are taken within 24 hours. These are checked for bacteria.

• Echocardiogram (echo). Sound waves (ultrasound) are used to create a picture of the heart. This lets the healthcare provider check for signs of infection and problems with heart structure and heart function. This can be done by passing a probe over the chest where the heart is located (transthoracic). Or it may be done by passing a tiny probe down the esophagus to get a closer view of the heart (transesophageal).

• Treatment for ID is antibiotics given through an IV line. This may be needed for as long as 6 weeks. It's dependent on the type of bacteria causing the infection and the specific location of the infection within the heart. Treatment is started in the hospital. But it may be completed in the hospital or at home. Blood tests are done during the course of the treatment. These help to make sure that the infection is no longer in the bloodstream. They can also evaluate for harmful effects of the antibiotics being used.

• In certain cases, your child may need surgery. This can happen if the bacteria can't be cleared from the blood. Or if there is significant damage to the heart valves as a result of the infection. Your child’s healthcare provider will tell you more about this treatment, if needed.

• Know the signs and symptoms of IE. Tell your child’s healthcare provider right away if you suspect your child is ill due to IE.

• Teach your child good oral hygiene. Make sure your child brushes and flosses daily. Also, schedule regular teeth cleanings for your child.

• Tell all of your child’s healthcare providers that your child is at risk for IE. Your child may need to take antibiotics before and after certain dental or medical treatments are done. This helps reduce the risk of infection.

Unless advised otherwise by your child’s healthcare provider, call the provider right away if:

• Your child has a fever of 100.4°F (38°C), or as directed by your healthcare provider (see Fever and children, below)

• Your baby is fussy or cries and can't be soothed.

• Your child has a fever that comes and goes.

• Blood in the urine

• Unexplained fatigue

How to take a child’s temperature

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.
• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.