Hepatitis B Vaccinations

At birth, infants have protection against certain diseases because antibodies have passed through the placenta from the mother to the unborn child. After birth, breastfed babies get the continued benefits of additional antibodies in breast milk. But in both cases, the protection is temporary.

Immunization (vaccination) is a way of creating immunity to certain diseases by using small amounts of a killed or weakened microorganism that causes the particular disease.

Microorganisms can be viruses, such as the measles virus, or they can be bacteria, such as pneumococcus. Vaccines stimulate the immune system to react as if there were a real infection — it fends off the "infection" and remembers the organism so that it can fight it quickly should it enter the body later.

Some parents may hesitate to have their kids vaccinated because they're worried that the children will have serious reactions or may get the illness the vaccine is supposed to prevent. Because the components of vaccines are weakened or killed — and in some cases, only parts of the microorganism are used — they're unlikely to cause any serious illness. Some vaccines may cause mild reactions, such as soreness where the shot was given or fever, but serious reactions are rare.

The risks of vaccinations are small compared with the health risks associated with the diseases they're intended to prevent.

The following vaccinations and schedules are recommended by the American Academy of Pediatrics (AAP). Please note that some variations are acceptable and that changes in recommendations frequently occur as new vaccines are developed. Many of these vaccines are available as combinations to reduce the number of shots a child receives. Your doctor will determine the best vaccinations and schedule for your child.

Recommended vaccinations:

Hepatitis B

Hepatitis B virus (HBV) affects the liver. Those who are infected can become lifelong carriers of the virus and may develop long-term problems such as cirrhosis (liver disease) or cancer of the liver.

Immunization Schedule

Hepatitis B vaccine usually is given as a series of three injections. The first shot is often given to infants shortly after birth. If the mother of a newborn carries the hepatitis B virus in her blood, the infant needs to receive the first shot within 12 hours after birth, along with another shot (HBIG) to immediately provide protection against the virus. If a newborn's mother shows no evidence of HBV in her blood, the infant may receive the hepatitis B vaccine any time prior to leaving the hospital. It may also be delayed until the 1- or 2- month visit to your doctor.

If the first dose is given shortly after birth, the second shot is given at 1 to 2 months and the third at 6 to 18 months. For infants who don't receive the first shot until 1 to 2 months, the second shot is given at 3 to 4 months and the third at 6 to 18 months. In either case, the second and third shots are usually given in conjunction with other routine childhood immunizations.

Why the Vaccine Is Recommended

The hepatitis B vaccine usually creates long-term immunity. Infants who receive the HBV series should be protected from hepatitis B infection not only throughout their childhood but also into the adult years. Eliminating the risk of infection also decreases risk for cirrhosis of the liver, chronic liver disease, and liver cancer. Young adults and adolescents should also receive the vaccine if they did not as infants.

Possible Risks

Serious problems associated with receiving the HBV vaccine are rare. Problems that do occur tend to be minor, such as fever or redness or tenderness at the injection site.

When to Delay or Avoid Immunization

• if your child is currently sick, although simple colds or other minor illnesses should not prevent immunization
• if a severe allergic reaction (called anaphylaxis) occurred after a previous injection of the HBV vaccine

Caring for Your Child After Immunization

The vaccine may cause mild fever, and soreness and redness in the area where the shot was given. Depending on the age of your child, pain and fever may be treated with acetaminophen or ibuprofen. Very young infants should not be given either medication, but for older infants or children, you can check with the doctor about the appropriate dose.

When to Call the Doctor

• if you're not sure of the recommended schedule for the hepatitis B vaccine
• if you have concerns about your own HBV carrier state
• if moderate or serious adverse effects appear after your child has received an HBV injection

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Thalassemias

What Are Thalassemias?

Thalassemias are genetic disorders that involve the decreased and defective production of hemoglobin, a molecule found inside all red blood cells (RBCs) that transports oxygen throughout the body.

As frightening as thalassemias can be, the outlook is encouraging. In the past 20 years, new therapies have greatly improved the quality of life and life expectancy in kids who have these diseases.

Thee two types of thalassemia are alpha-thalassemia and beta-thalassemia. Their names describe which part of the hemoglobin molecule that is effected, the alpha or the beta chain. Hemoglobin contains two different kinds of protein chains named alpha and beta chains. Any deficiency in these chains causes abnormalities in the formation, size, and shape of RBCs.

Thalassemia can cause ineffective production of RBCs and their destruction. As a result, people with thalassemia often have a reduced number of RBCs in the bloodstream (anemia), which can affect the transportation of oxygen to body tissues. In addition, thalassemia can cause RBCs to be smaller than normal or drop hemoglobin in the RBCs to below-normal levels.

Kids who have with different forms of thalassemia have different kinds of health problems. Some only have mild anemia with little or no effects, while others require frequent serious medical treatment.

Causes

Thalassemia is always inherited, passed on from parents to children through their genes. A child usually does not develop symptoms unless both parents carry a thalassemia gene.

If only one parent passes a gene for thalassemia on to the child, then the child is said to have thalassemia trait. Thalassemia trait will not develop into the full-blown disease, and no medical treatment is necessary.

Many families have thalassemia carriers, but the trait often goes undiagnosed because it produces no or few symptoms. Frequently, thalassemia is not diagnosed in a family until a baby is born with it. So if someone in your family carries a thalassemia gene, it's wise to have genetic counseling if you're thinking of having children.

At one time it was believed that the disease affected only people of Italian or Greek descent, but it's now known that many people with thalassemia also come from or are descended from Africa, Malaysia, China, and many parts of Southeast Asia.

Because of a recent pattern of migration from Southeast Asia, there has been an increase in the past decade of thalassemia in North America. Testing for thalassemia is generally recommended for anyone from Southeast Asia with unexplained anemia.

If your doctor determines that your child is at risk for thalassemia, prenatal tests can find out if your unborn child is affected.

Types of Thalassemias

Alpha-Thalassemia

Children with alpha-thalassemia trait do not have thalassemia disease. People normally have four genes for alpha globin, two inherited from each parent. If one or two of these four genes are affected, the child is said to have alpha-thalassemia trait.

A specific blood test called a hemoglobin electrophoresis is used to screen for alpha-thalassemia trait and can be done in infancy. Sometimes, alpha-thalassemia trait can be detected through routine newborn blood screening, which is required in most states in the U.S.

Often, results of the hemoglobin electrophoresis test are normal in people who have alpha-thalassemia trait and a diagnosis of alpha-thalassemia is done only after other conditions are ruled out and after the parents are screened. The disease can be harder to detect in older kids and adults.

Kids who have the alpha-thalassemia trait usually have no significant health problems except mild anemia, which can cause slight fatigue.

Alpha-thalassemia trait is often mistaken for an iron deficiency anemia because RBCs will appear small when viewed under a microscope.

Other cases can cause more severe anemia where three genes are affected. People with this form of alpha-thalassemia may require occasional blood transfusions during times of physical stress, like fevers or other illnesses, or when the anemia is severe enough to cause symptoms such as fatigue.

The most severe form of the disorder is called alpha-thalassemia major. This type is extremely rare, and women carrying fetuses with this form of thalassemia have a high incidence of miscarriage because the fetuses cannot survive.

Beta-Thalassemia

Beta-thalassemia, the most common form of the disorder seen in the United States, is grouped into three categories: beta-thalassemia minor (trait), intermedia, and major (Cooley's anemia). A person who carries a beta-thalassemia gene has a 25% (1 in 4) chance of having a child with the disease if his or her partner also carries the trait.

Recently, some kids have successfully undergone bone marrow transplants to treat thalassemia major; however, this is considered only in cases of severely disabling thalassemia disease. There is considerable risk to bone marrow transplants: the procedure involves the destruction of all of the blood-forming cells in the bone marrow and repopulating the marrow space with donor cells that must match perfectly (the closest match is usually from a sibling).

The procedure is usually done in children younger than 16 years of age who have no existing evidence of liver scarring or serious liver disease. Results have been encouraging so far, with disease-free survival in many patients.

Blood-forming stem cells taken from umbilical cord blood have also been successfully transplanted, and research using this technique is expected to increase. Currently bone marrow treatment is the only known cure for the disease.

Talking to the Doctor

If you know the thalassemia trait exists in your family, it's important to meet with your doctor, particularly if you notice any of the symptoms of thalassemia major — anemia, listlessness, or bone abnormalities — in your child.

If you're thinking of having children, speak with a genetic counselor to determine your risk of passing on the disease.

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Sickle Cell Disease

Sickle cell disease is an inherited disorder in which red blood cells (RBCs) are abnormally shaped. This abnormality can result in painful episodes, serious infections, chronic anemia, and damage to body organs.

These complications can, however, vary from person to person depending on the type of sickle cell disease each has. Some people are relatively healthy and others are hospitalized frequently.

But thanks to advancements in early diagnosis and treatment, most kids born with this disorder grow up to live relatively healthy and productive lives.

A Closer Look at Sickle Cell Disease

The different forms of sickle cell disease are determined by the genes inherited from the person's parents.

Someone who has the disease has inherited a sickle cell gene from each parent (hemoglobin SS disease, also called sickle cell anemia).

A person can also inherit a sickle cell gene from one parent and a different kind of abnormal gene from the other and end up with a different form of sickle cell disease, such as hemoglobin SC disease or hemoglobin S-thalassemia.

Someone who inherits only one sickle cell gene and a normal gene from the other parent will have the sickle cell trait, but not the disease. A blood test can determine whether you have sickle cell disease or carry the sickle cell trait.

People with sickle cell trait don't have sickle cell disease or exhibit any signs of the disorder, but they can pass the gene for the disease to their children. When both parents have the sickle cell trait, there's a 25% chance that a child will have sickle cell disease. But when one parent is carrying the trait and the other actually has the disease, the odds increase to 50% that their child will inherit the disease.

Who Is Affected?

In the United States, hemoglobin SS disease (sickle cell anemia) affects mostly African Americans. Some forms of sickle cell disease may occur, although less frequently, in people with different ethnic backgrounds, such as those whose ancestors came from Mediterranean countries (including Turkey, Greece, and Italy), East India, or Middle Eastern countries.

Causes of Sickle Cell Disease

A child with sickle cell disease has inherited two defective hemoglobin genes. The hemoglobin can take on an abnormal shape, distorting the shape of the red blood cell. The cells change from a normal round, doughnut shape to the elongated shape of a sickle, or the shape of the letter "C."

Unlike normal RBCs, which move easily through small blood vessels, sickle cells are stiff and pointed. The sickle shape means that they have a tendency to get stuck in narrow blood vessels and block the flow of blood. This can cause episodes of pain and can also lead to organ damage because the cells aren't getting enough oxygen.

Sickle cells have a shorter-than-normal life span, which leads to anemia (low red blood cell count). A normal red blood cell lives for about 120 days, whereas a sickle cell lives for only 10 to 20 days.

Diagnosis

Usually, sickle cell disease is diagnosed at birth with a blood test. This can be done in conjunction with other routine newborn screening tests. If a child tests positive on the screening test, a second blood test is usually performed to confirm the diagnosis.

Because kids with sickle cell disease are at an increased risk of infection and other health complications, early diagnosis and treatment is important. Currently, more than 40 states require newborn screening programs for sickle cell disease.

Signs and Symptoms

Symptoms of sickle cell disease vary and range from mild to severe, and symptoms may be less severe or different in children who have inherited a sickle cell gene from one parent and a different abnormal hemoglobin gene from the other.

Most kids with sickle cell disease have some degree of anemia and might develop one or more of the following conditions and symptoms as part of the disorder:

Acute chest syndrome: Inflammation or trapped red blood cells in the lungs cause this syndrome. Signs include chest pain, coughing, difficulty breathing, and fever.

Aplastic crisis: This is when the bone marrow temporarily slows its production of RBCs due to infection or another cause, resulting in a severe drop in the red cell count and severe anemia. Signs include paleness, fatigue, and rapid pulse.

Hand-foot syndrome (also called dactylitis): This painful swelling of the hands and feet, plus fever, may be the first sign of sickle cell anemia in some infants.

Infection: Kids with sickle cell disease are at increased risk for certain bacterial infections. It's important to watch for fevers of 101° Fahrenheit (38° Celsius) or higher, which could signal an infection. Children with sickle cell disease and fever should be seen by a doctor immediately.

Painful crises: These may occur in any part of the body and may be brought on by cold or dehydration. The pain may last a few hours or up to 2 weeks or even longer, and may be so severe that a child needs to be hospitalized.

Splenic sequestration crises: The spleen becomes enlarged by trapping (or "sequestering") the abnormal RBCs. This leads to fewer cells in the general circulation. Early signs include paleness, weakness, an enlarged spleen, and pain in the abdomen.

Stroke: Poor blood flow in the brain can occur when the sickle-shaped cells block small blood vessels. This may lead to a stroke. Signs can include headache, seizures, weakness of the arms and legs, speech problems, a facial droop, and loss of consciousness.

Other possible complications include leg ulcers, bone or joint damage, gallstones, kidney damage, painful prolonged erections in males (priapism), eye damage, and delayed growth.

Treatment

Aside from a bone marrow transplant, there is no known cure for sickle cell disease. Transplants are complicated procedures and aren't an option for everyone. To qualify, a child would need bone marrow from a "matched" donor with a low risk of being rejected. Even then, there are significant risks to the procedure and there's always the chance of rejection of the transplanted marrow.

But even without a cure, kids with sickle cell disease can lead relatively normal lives. Medicines are available to help manage the pain, and immunizations and daily doses of penicillin (an antibiotic) can help prevent infection.

Infection used to cause many deaths in infants with sickle cell disease, but thanks to penicillin and appropriate immunizations, children with sickle cell disease are much more likely to live longer, healthier lives. Although penicillin isn't a cure, it can help prevent life-threatening infections due to bacteria that cause serious infections such as sepsis (a severe infection in the blood), meningitis, and pneumonia.

Infants and kids with sickle cell disease usually require two daily doses of penicillin, as prescribed by their doctors, until they're at least 5 years old (and often older). In addition, they should be fully immunized with the regular childhood vaccinations, including the pneumococcal vaccine and influenza and meningococcal vaccines.

Most doctors also prescribe daily vitamin supplements. Folic acid, in particular, can help a child with the disorder produce new RBCs.

In addition, kids who develop serious complications (such as acute chest syndrome, severe anemia, or stroke) may receive regular transfusions of red blood cells to prevent or treat these complications.

In 1998 the U.S. Food and Drug Administration (FDA) approved the drug hydroxyurea for use in adults with sickle cell disease; while it still has not been officially approved for use in children, it can be used by specialists in some circumstances.

Hydroxyurea increases the amount of fetal hemoglobin in blood cells, which interferes with the sickling process and makes red blood cells less sticky. This helps decrease the number and intensity of painful episodes and other complications. The drug has been proven to decrease pain and other complications in children as well as adults. Research is continuing to determine the drug's long-term effects and safety.

When to Call the Doctor

Seek emergency medical attention immediately if your child develops any of the following:

• fever of 101° Fahrenheit (38° Celsius) or higher
• pain that isn't relieved by oral medication
• chest pain
• shortness of breath or trouble breathing
• severe headaches or dizziness
• severe stomach pain or swelling
• jaundice or extreme paleness
• painful erection in males
• sudden change in vision
• seizures
• weakness or inability to move any part of the body
• loss of consciousness

Caring for Your Child

In addition to the primary care doctor, your child should receive regular care from a hematologist (a blood specialist) or a sickle cell specialty clinic. It's important to share your concerns and discuss any new symptoms or complications with your child's health care team.

Your child also should drink lots of fluids, get plenty of rest, and avoid extreme temperatures.

Most people with sickle cell disease now live into their mid-40s and beyond. A critical time is the first few years of life, which is why early diagnosis and treatment are so important.

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Port Wine Stains

About Port-Wine Stains

About 3 out of every 1,000 kids are born with a port-wine stain — a birthmark that literally looks like maroon wine was spilled or splashed on the skin. Though they often start out looking pink at birth, port-wine stains tend to become darker (usually reddish-purple or dark red) as kids grow.

Port-wine stains (also known as nevus flammeus) can be anywhere on the body but most commonly are found on the face, neck, scalp, arms, or legs. They can be any size, and usually grow in proportion with a child. They often change in texture over time, too — early on, they're smooth and flat but they may thicken and feel like pebbles under the skin during adulthood.

For most kids, port-wine stains are no big deal — they're just part of who they are. And some port-wine stains are barely noticeable, especially when they're located somewhere other than the face.

But port-wine stains often get darker and can sometimes become disfiguring and embarrassing for children. Port-wine stains (especially on the face) can make kids feel self-conscious, particularly during the already challenging preteen and teen years when kids are often more interested in blending in than standing out.

Although port-wine stains won't go away on their own, they can be treated. In fact, laser therapies can make many port-wine stains much less noticeable and give kids' self-esteem a much-needed boost.

Cause

Port-wine stains happen when an area of skin doesn't get any (or an insufficient) supply of nerve fibers, which normally help keep blood vessels narrow. When there's a lack of nerve fibers, small blood vessels (called capillaries) keep expanding, allowing a greater amount of blood to flow into the blood vessels, causing a stain to form under the skin. Birthmarks that form like this are called vascular birthmarks.

Port-wine stains can't be prevented — and they're not caused by anything a mother did during pregnancy.

Diagnosis

Your doctor can sometimes tell if your child has a port-wine stain or a different kind of vascular birthmark by looking at your child's skin.

Vascular birthmarks called macular stains (also known as salmon patches, angel kisses, or stork bites) may resemble port-wine stains. They're faint red marks often found on the forehead or eyelids, the back of the neck, or on the nose, upper lip, or on the back of the head. These often fade on their own by the time a child is 1 to 2 years old.

Port-wine stains also may be confused with hemangiomas. Superficial (formerly called "strawberry") hemangiomas are bright red, raised birthmarks. Deep hemangiomas (once called "cavernous") are a bluish-red, puffier birthmark. Hemangiomas, which are also found on the head or neck, grow quickly during infants' first 6 months or so, but usually shrink back and disappear by the time a child is 5 to 9 years old.

Port-wine stains are usually nothing more than a harmless birthmark that doesn't cause any problems or pain. However, they're sometimes (though very rarely) a sign of other medical conditions.

For example, port-wine stains on or near the eye or on the forehead need to be monitored. That's because they may be associated with a sort of "stain on the brain" (a very uncommon neurological disorder called Sturge-Weber Syndrome that causes problems like seizures, developmental delays, and learning disabilities). Stains on the eyelids may also, rarely, lead to glaucoma — increased pressure inside the eye that can affect vision and lead to blindness if left untreated.

If there's a concern about the location of a port-wine stain or accompanying symptoms, your doctor may order tests (such as eye tests or imaging tests like an X-ray, CT scan, or MRI) to see what's going on and rule out an underlying problem. If your child has a birthmark anywhere on the body it's important for your doctor examine it to see what type it is and what kind of monitoring and treatment it needs, if any.

Treatment

Although some port-wine stains are small and hard to see, some can be really upsetting for kids, especially if they're large, dark, or on the face. And any birthmark can take a toll on a child's self-confidence, no matter how large or small the mark might be.

The good news is that lasers (highly concentrated light energy) can make many kids' port-wine stains much lighter, especially when the birthmark is on the head or neck. Dermatologist or plastic surgeons usually give several treatments with the laser of choice for port-wine stains called a "pulsed-dye" laser.

Laser treatment is often started in infancy when the stain and the blood vessels are smaller and the birthmark is much easier to treat. But that doesn't mean laser treatments can't help older kids or teens, too — it's just that the longer someone has had the stain, the harder it might be to successfully treat it.

Laser therapy doesn't hurt a lot, but can be uncomfortable. During the treatment, kids can usually be given an anesthetic (given as a shot, spray, or ointment to numb the area to so it doesn't hurt as much). Young kids may also be given general anesthesia to help them sleep or relax during the procedure. After treatment, the area might be swollen and bruised at first, but it will be back to normal in 7 to 10 days.

For port-wine stains that have become bumpy, thick, or raised, doctors sometimes need to use another type of laser or surgery. Port-wine stains can also develop grape-like growths of small blood vessels called vascular blebs — these aren't usually cause for concern but they often bleed and may need to be removed.

In the past some people have opted for other treatments, too (like freezing, tattooing, even radiation). But these aren't as effective — or as safe — as laser therapy. Laser surgery is the only treatment that works on port-wine stains with less risk of damaging or scarring the skin. Sometimes, though, laser treatments may make the area look lighter or darker than normal, although this usually is just temporary.

And laser treatments may not get rid of the birthmark entirely (though a few kids' birthmarks do disappear altogether after treatment). Plus, over time the birthmark may come back and need to be retreated.

For a small number of kids, laser treatment might not work at all. Every child's port-wine stain is different, so whether or not the treatment works well will be different for each child, too.

Care

Port-wine stains can get very dry sometimes, so it's important to use a moisturizer. Also be sure to call the doctor if your child's port-wine stain ever bleeds, hurts, itches, or becomes infected. Like any injury where there's bleeding, make sure to clean the wound with soap and water and use a gauze bandage to place firm pressure on the area until the bleeding stops. If the bleeding doesn't stop, call your doctor.

If your child's port-wine stain has been treated with laser surgery, avoid rubbing or scratching the area, and gently cleanse it with lukewarm water. Your doctor may prescribe an ointment to aid in healing and help prevent infection.

Helping Kids Cope

As with any birthmark, port-wine stains (especially on the face) can make kids feel different and insecure about how they look. If it's clearly visible, people might ask questions or stare, which can be hurtful for both you and your child. Even at a young age, kids watch how their parents respond to these situations and take cues about how to cope with others' reactions.

Practice responses so your child will feel more prepared when asked about it. It can help to have a simple, calm, nonchalant explanation ready like, "It's just a birthmark. I was born with it."

Talking simply and openly about a birthmark with kids makes them more likely to accept it as just another part of themselves — like their height or eye color. It's also important, emotionally, for kids to be around supportive family and friends who treat them like everyone else.

Of course, it's still natural for kids to want to do whatever they can to minimize a birthmark. In addition to laser treatments, special cover-up makeup can camouflage the stain and make living with it a little easier.

Still, kids with port-wine stains (or any birthmark, really) need to know that they're no different from other kids. If anything, it may help to tell your child that kids born with a port-wine stain are unique in a good way — it's a special, colorful part of themselves that few other people have.

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Mitral Valve Prolapse

Mitral valve prolapse (MVP), a very common heart condition, occurs when one of the heart's valves doesn't work properly. MVP can be frightening because it involves the heart and can cause sharp chest pains, but it isn't a critical heart problem or a sign of other serious medical conditions.

Because MVP often doesn't produce any symptoms or interfere with everyday life, in many cases it isn't diagnosed until adulthood. But with kids who are diagnosed, it's important to know what the symptoms are, so that you can distinguish them from signs of any other more serious heart issues.

What Is the Mitral Valve?

To understand mitral valve prolapse, it's helpful to review some basics about the way a healthy heart works.

• The heart is made up of four distinct chambers: two atria (the two upper chambers) and two ventricles (the two lower chambers).
• During circulation, blood flows from all over the body into the heart's right atrium.
• From there the blood travels to the right ventricle, which pumps the blood to the lungs to receive oxygen.
• Once the blood has been infused with oxygen, it returns from the lungs to the heart's left atrium.The oxygen-rich blood then passes into the left ventricle, which pumps it out to the body through a large blood vessel known as the aorta.

The mitral valve is located between the left atrium and the left ventricle and helps control the flow of blood as it passes from the left atrium into the left ventricle. The valve has two flaps of tissue — known as leaflets — that open and close together like a pair of swinging doors. Each time the heart beats, the left ventricle pumps blood out to the body and the flaps of the mitral valve swing shut to prevent the blood in the ventricle from flowing backward into the left atrium.

In cases of MVP, one or both of the mitral valve's flaps bulge back into the atrium when they are shut, a bit like a balloon. This may occur because one of the flaps is abnormally shaped or a little too large.

In some cases, when the flaps do not close evenly, blood is allowed to leak back into the left atrium. This is called mitral regurgitation. A tiny amount of mitral regurgitation is normal. In some cases, there's more leakage, which can cause a heart murmur a whooshing sound between the normal lub-dub of the heartbeat. (Because of these sounds, MVP is sometimes called click-murmur syndrome, floppy valve syndrome, or balloon mitral valve.)

In most cases, the cause of MVP is unknown. Sometimes kids are born with the condition. In other cases, it develops after some sort of inflammatory condition, like endocarditis, an inflammation of the inner lining of the heart, or rheumatic fever, an inflammation that can affect the joints and the heart.

MVP may be diagnosed in people who have other health conditions that affect the body's connective tissue, such as Marfan syndrome. Some research has shown that kids with MVP may be more likely to also have an arrhythmia, an irregular heartbeat.

Signs and Symptoms

Many people with MVP have no symptoms. In some cases, though, the flaps of the mitral valve make a clicking sound when they close. A doctor may be able to hear this noise when listening to the heart with a stethoscope. Someone who has MVP and mitral regurgitation may also have a heart murmur, a sound caused by some blood moving backward into the left atrium. When a click and a murmur are heard together, the click happens first, as the flaps close, followed by the murmur as the blood leaks back into the atrium through the improperly closed valve.

Kids with MVP also may experience:

• dizziness or lightheadedness
• fatigue
• shortness of breath or trouble breathing after exertion
• a feeling that the heart is skipping beats or beating very quickly
• chest pain that comes and goes

The chest pain is often sharp but it can vary from person to person. Learn to recognize the symptoms, and call your doctor if your child has chest pain that:

• consistently occurs during physical exertion (exercise or sports)
• creates pressure and a crushing sensation
• occurs with other symptoms (palpitations that last more than a few seconds, dizziness, fainting, or shortness of breath)

Diagnosis and Treatment

In most cases, MVP is diagnosed during a routine exam when a doctor listens to the heart with a stethoscope and hears a different sound. If the doctor hears a click or a murmur that indicates MVP, your child may be referred to a pediatric cardiologist, a doctor who specializes in diagnosing and treating heart conditions in kids.

The cardiologist will perform a thorough physical exam and listen to the heart. Then he or she may order tests — including an echocardiogram (echo) and an electrocardiogram (EKG or ECG) — to find out what's causing the sound. An echo uses sound waves to create a picture of the heart and its blood flow, and an EKG records electrical activity in the heart. If a child has MVP, the bulging valve flaps will probably be seen on the echo when the heart beats.

Kids who are diagnosed with MVP usually require no medical treatment. In some cases where MVP causes significant regurgitation, blood pressure medication is prescribed to control how hard the heart muscle must work. (With blood leaking back into the atrium, the heart works harder to pump the normal amount of blood out to the body.) A child who has an arrhythmia in addition to MVP may need to take medicine to help regulate the heart's rhythm. In rare cases, surgery may be done to repair a very leaky mitral valve.

Caring for a Child With MVP

Kids with MVP who have no other medical conditions typically require no special care. A child with MVP who plays competitive sports will be able to continue doing so as long there's no mitral regurgitation or active symptoms from the MVP. A child who does have regurgitation or symptoms will have to be cleared by the doctor to participate in sports. This may involve some additional tests.

Although any heart condition can be frightening, mitral valve prolapse likely will not have any impact on your child's everyday life and activities. If you have any questions or concerns, speak with your doctor.

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