ECG Interpretation: What Is Different in Children?

In most clinical settings, EKG machines are used to detect heart abnormalities in adults, but for those who work with children, it is important to know the differences in what is considered “normal” for these tests. Just like the heart rate of a child is dissimilar to that of an adult, the parameters to be studied in an electrocardiogram are also different. Children also develop common arrhythmias that may not be seen in adults, so their treatment options will vary.

EKG machines still study the same waveforms (P, QRS and T) in a child’s heart, because the conduction pathways are the same, and the approach to analyzing these signals doesn’t change from child to adult. Even the mechanisms of arrhythmias occur similarly in adults and children. However, there are important differences in how these ECG results are understood and interpreted.

For example, children shift from right ventricular dominance as newborns into left ventricular dominance by the time they reach their first birthday. Another major difference in the ECG interpretation for children is the type of arrhythmias (abnormal rhythms) that are most commonly seen. The most common ones include bradycardia, sinus arrhythmia, and supraventricular tachycardia. Adults are more likely to see results such as atrial fibrillation or flutter, and ventricular tachycardia, which are rarely seen in a child’s EKG results.
Each of these conditions must be carefully studied, in relation to how it may affect children differently than adults. Pediatric EKG tests should only be evaluated by individuals who are aware of these differences may impact the ultimate diagnosis and treatment of the patient.

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