Key Practice Recommendations

1. Refer newborns, infants, and children with a murmur, cardiac symptoms, or characteristics of a pathologic murmur to a pediatric cardiologist.
Strength of Recommendation: C
Source: Ford B, Sebastian L. Heart murmurs in children: evaluation and management. Am Fam Physician. 2022;105(2):251-261.

2. Consider referring infants with a persistent murmur to a pediatric cardiologist.
Strength of Recommendation: C
Source: Ford B, Sebastian L. Heart murmurs in children: evaluation and management. Am Fam Physician. 2022;105(2):251-261.

3. Screen adolescent and college athletes for cardiovascular abnormalities with a questionnaire and physical examination.
Strength of Recommendation: B
Sources: Bernhardt DT, Roberts WO, eds. PPE Preparticipation Physical Evaluation. 5th ed. American Academy of Pediatrics. 2019.
Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;115(12):1643-1655.

4. Use electrocardiography to initially evaluate patients with a suspected dysrhythmia and consider prolonged cardiac monitoring.
Strength of Recommendation: B
Source: Borquez AA, Williams MR. Essentials of paroxysmal supraventricular tachycardia for the pediatrician. Pediatr Ann. 2021;50(3):e113-e120.

5. Consider a diagnosis of Kawasaki disease in children with a fever for 5 days or more and at least four of five principal clinical features: extremity changes, rash, bilateral conjunctival injection that typically spares the limbus, oral changes, and cervical lymphadenopathy.
Strength of Recommendation: B
Source: McCrindle BW, Rowley AH, Newberger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-e999.

6. Instruct athletes with cardiac magnetic resonance imaging study signs consistent with COVID-19 or mRNA vaccine–associated myocarditis to not exercise for 3 to 6 months.
Strength of Recommendation: B
Source: Gluckman TJ, Bhave NM, Allen LA, et al. 2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post sequelae of SARS-CoV-2 infection, and return to play. J Am Coll Cardiol. 2022;79(17):1717-1756.