Bradycardia in Children: Evaluation and Management

Definition and Normal Heart Rate

The American Heart Association defines bradycardia as a heart rate below 60 beats per minute, with symptomatic bradycardia typically occurring when the rate falls below 50 beats per minute in children 1, 2
For a 10-year-old child, normal heart rate ranges from 70-115 beats per minute after age 3 years 3

The critical question is whether bradycardia is causing symptoms or represents an underlying pathologic condition, requiring immediate assessment for signs of poor perfusion, hemodynamic instability, or respiratory compromise 4
Signs of poor perfusion include altered mental status, dizziness, syncope, chest discomfort, or fatigue, while hemodynamic instability may present with hypotension, signs of shock, or acute heart failure 1, 2, 4
Respiratory compromise, such as increased work of breathing or hypoxemia, should also be evaluated 4

Reversible or treatable causes of bradycardia include medications like beta-blockers or calcium channel blockers, electrolyte abnormalities, hypothyroidism, increased intracranial pressure, and infections 4
Cardiac causes, such as sinus node dysfunction, atrioventricular blocks, or congenital heart disease, should also be considered 5
Immediate action required includes obtaining a 12-lead ECG, continuous monitoring, checking for symptoms of poor perfusion or hemodynamic compromise, and evaluating for reversible causes 1, 2, 4