Heart murmur assessment in children (Paediatric heart murmur assessment)
A check to find out whether the extra heart sound (murmur) heard in a child is a harmless 'innocent' murmur or a sign of an underlying heart problem.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A murmur is an extra heart sound, not a diagnosis — most murmurs in children are harmless 'innocent' murmurs and need no treatment.
- The assessment exists to tell an innocent murmur apart from a murmur caused by an underlying heart problem.
- Much of the answer comes from listening and examining; an echocardiogram (heart ultrasound) is the test that settles any doubt, and it is usually not painful and harmless.
- Tell the clinician about any breathlessness, poor feeding or growth, blue spells, fainting, chest pain or a family history of heart problems, as these change how a murmur is judged.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Distinguishes a harmless innocent murmur from a murmur caused by a heart problem
A child with signs of a serious heart problem or severe breathing difficulty needs urgent assessment, not a routine outpatient appointment.
The clinician examines your child and explains what the murmur sounds like and whether it has the features of an innocent murmur. Ask them to be clear...
A clear statement of whether the murmur is innocent or under investigation, ideally in writing
The clinician examines your child and explains what the murmur sounds like and whether it has the features of an...
An echocardiogram is done the same day or at a later appointment. It is usually not painful and your child can...
A normal examination and/or echocardiogram means the murmur is innocent and the heart is structurally normal —...
Your child is referred to a paediatric cardiologist, who explains the condition, whether it needs monitoring or...
What is a heart murmur assessment in a child?
A heart murmur is an extra 'whooshing' sound a clinician hears through a stethoscope as blood flows through the heart. Murmurs are very common in babies and children, and most are completely harmless. A murmur is a sound, not a diagnosis — the point of an assessment is to work out what is causing it.
Many children have what is called an innocent (or functional) murmur. This is the sound of normal blood flowing through a normal heart, often heard more loudly when a child is unwell, has a fever, or is excited. An innocent murmur is not a heart problem and usually needs no treatment, often fading as the child grows.
A small number of murmurs are caused by an underlying heart condition, such as a hole in the heart or a valve that is narrow or leaky. The assessment is designed to tell these apart — mainly by listening carefully and examining the child, and by arranging a heart scan (echocardiogram) if there is any doubt.
The key message for parents is reassuring but honest: most childhood murmurs are innocent, but a murmur is assessed precisely so that the few that matter are not missed.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Innocent (functional) murmur
The sound of normal blood flow through a normal heart, common in well children. It often gets louder with fever or excitement and changes with position, and it needs no...
Still's murmur
The most common type of innocent murmur in young children — a soft, musical sound at the front of the chest in a child who is otherwise completely well.
Murmur due to a structural heart problem
Caused by a hole in the heart, a narrowed or leaky valve, or another structural difference. These often have other features and usually need specialist (paediatric...
Clinical examination by a doctor
Listening to the heart in different positions, feeling the pulses, checking growth and colour, and asking about symptoms and family history. This alone often identifies an...
Preparing for your test
- Note when the murmur was first heard (often at a routine check or during an illness) and whether your child was unwell at the time.
- Write down any symptoms: breathlessness, getting tired or breathless with feeding or play, poor weight gain, blue or grey spells, fainting or chest pain.
- Bring details of your child's birth, growth, and any health problems, plus their red book if you have it.
- Note any family history of heart conditions, especially conditions present from birth or sudden heart problems at a young age.
- For an echocardiogram, dress your child in easy-to-remove clothing; younger children may sit on a parent's lap, and no fasting or special preparation is usually needed.
- Bring a favourite toy, book or device to help a young child stay calm and still during the scan.
What happens
The clinician listens to your child's heart carefully, often in more than one position (for example sitting and lying down), because innocent murmurs typically change with position and get louder when the heart beats faster. They will feel the pulses, check your child's colour and growth, and ask about symptoms and family history.
In many well children with a typical innocent murmur and no concerning features, an experienced clinician can give reassurance at this point without further tests. If there is any doubt — an unusual-sounding murmur, symptoms, abnormal pulses, or a relevant family history — they will usually arrange an echocardiogram.
An echocardiogram is a usually not painful ultrasound scan of the heart. A small probe with gel is moved over the chest to show the heart's chambers, valves and blood flow on a screen. It does not use radiation. A normal echocardiogram is strong reassurance that the heart is structurally normal.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A child with signs of a serious heart problem or severe breathing difficulty needs urgent assessment, not a routine outpatient appointment.
- Reassurance from listening alone is not enough when the murmur sounds atypical, there are symptoms, abnormal pulses, or a concerning family history — an echocardiogram is needed.
- An ECG and chest X-ray are not the right tests for sorting an innocent murmur from a structural one; the echocardiogram is the key investigation.
- Repeated investigation is unhelpful once a murmur is confidently innocent and the child is well.
Delay or rearrange if…
- A murmur heard only during a feverish illness in a well child may be reassessed once the illness has settled.
- A young child too distressed to allow a good scan may need the echocardiogram rescheduled for a calmer or specialist setting.
- If a baby is acutely unwell, the immediate illness is assessed and stabilised first, with the murmur interpreted in that context.
- Do not delay if a child has blue spells, severe breathlessness, fainting or poor feeding with poor growth — these need prompt assessment.
Alternatives to discuss
- Watchful clinical review for a typical innocent murmur in a well child, without immediate scanning
- Echocardiogram when there is any diagnostic doubt
- Referral to a paediatric cardiologist for an expert opinion
- NHS pathway via the GP if private review is not wanted
- Reassurance and no further action when the murmur is clearly innocent
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Distinguishes a harmless innocent murmur from a murmur caused by a heart problem
- Reassures families when the heart is normal — which is the most common outcome
- Identifies the small number of children who need treatment or specialist follow-up
- Avoids unnecessary tests and worry when the murmur is clearly innocent
- Provides a clear plan, including whether any follow-up is needed
Risks & complications
- A young child finding the examination or scan unfamiliar, wriggly or briefly upsetting
- Some uncertainty from listening alone, meaning a scan is arranged for reassurance
- Cool gel and a probe pressed gently on the chest during an echocardiogram (not painful)
- Needing to repeat or extend the assessment if a young child will not stay still for the scan
- An incidental, very minor finding on the scan that needs explanation but not treatment
- Anxiety from waiting for a specialist appointment or scan result
- A heart condition that is genuinely subtle and only becomes clearer over time or on detailed imaging
- Over-investigation — extra tests prompted by a clearly innocent murmur, with the worry that brings
The assessment itself is very low risk — listening and an ultrasound scan do not harm a child. The main thing to get right is judgement: a clearly innocent murmur in a well child usually needs only reassurance, while a murmur with any concerning feature deserves an echocardiogram and, if needed, a paediatric cardiology opinion. Always mention breathlessness, poor feeding or growth, blue spells, fainting or a family history of heart problems, as these change the picture.
Published figures to discuss
Useful population percentages are hard to apply to an individual child here. Innocent murmurs are very common and the proportion later found to have a structural cause depends heavily on the child's age, the murmur's characteristics and any symptoms or family history. Rather than attach a misleading single figure, the responsible approach is to assess each murmur on its features and use an echocardiogram whenever there is doubt. We have therefore not stated invented rates.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Innocent murmur | Common in children | Many childhood murmurs are normal flow murmurs, especially when a child is feverish or active. | Guide sourcesClinical context |
| Structural heart disease | Uncommon but important | Cyanosis, poor feeding, breathlessness, poor growth, chest pain with exertion, syncope or abnormal pulses need prompt assessment. | Guide sourcesClinical context |
| False reassurance from auscultation alone | Recognised | If the murmur has concerning features or symptoms are present, echocardiography or paediatric cardiology review may be needed. | Guide sourcesClinical context |
| Unnecessary restriction | Recognised | Children with innocent murmurs should not usually be restricted from normal activity once assessed. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from a heart murmur assessment. 'Afterwards' is about understanding the result — usually reassurance that the murmur is innocent — and knowing whether any follow-up or scan is planned.
- Your child behaving completely normally before and after the assessment
- An innocent murmur that is still heard at future checks but causes no problems
- An innocent murmur sounding louder when your child is unwell or feverish
- Many innocent murmurs becoming quieter or disappearing as your child grows
Aftercare
- Make sure you understand whether the murmur was judged innocent or needs further assessment.
- If reassured, treat your child completely normally — an innocent murmur does not limit activity, sport or vaccinations.
- Keep any follow-up or echocardiogram appointment that has been arranged.
- Mention the innocent murmur to other clinicians who may hear it in future, so it is not re-investigated unnecessarily.
- Seek medical advice if your child later develops breathlessness, poor feeding or growth, blue spells, fainting or chest pain.
- Ask for written confirmation of the finding if it would help with school, sport or future appointments.
- A clear note of whether the murmur is innocent or under investigation
- Any echocardiogram or follow-up appointment booked
- A list of symptoms that would mean seeking medical advice
- Your child's red book or health record updated
- Contact details for the clinic if questions arise
- Any letter or result you have been promised
⚠ Get urgent help if…
- Breathlessness, or getting tired or breathless with feeding, crawling, walking or play
- Poor feeding in a baby, sweating with feeds, or poor weight gain
- Blue or grey colour around the lips or tongue (on brown or black skin, check the lips, tongue, palms and soles)
- Fainting, blackouts, or fainting during exercise
- Chest pain that comes on with exertion
- A baby who is unusually breathless, floppy or unwell — seek urgent help (call 999 for severe breathing difficulty or a blue/grey colour)
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A 'good' result is an examination, and where needed an echocardiogram, showing a structurally normal heart — meaning the murmur is innocent. This is the most common outcome and is genuine reassurance: an innocent murmur is not a heart problem and does not limit your child.
A normal assessment reflects the heart as it is now. Most innocent murmurs simply fade with growth. If a structural problem is found instead, the result guides whether monitoring or treatment is needed, and your child is referred to a paediatric cardiologist.
Once a murmur is confidently identified as innocent, that reassurance generally holds and the murmur often disappears as the child grows. A normal echocardiogram is strong evidence the heart is structurally normal. If your child later develops symptoms such as breathlessness, fainting or chest pain, that is a reason for fresh assessment rather than assuming the earlier result still explains everything.
Related tests, treatments or support
A heart murmur assessment may be combined with an echocardiogram, and occasionally an ECG (a heart-rhythm tracing) or a check of blood pressure and oxygen levels. If a child is unwell, the murmur is interpreted alongside the wider assessment, since fever and illness commonly make an innocent murmur louder.
Follow-up & long-term care
Many children with a clearly innocent murmur need no follow-up at all. Others are reviewed once, or have an echocardiogram, to confirm the heart is normal. If a structural problem is found, the paediatric cardiology team arranges ongoing follow-up. You should always leave with a clear plan and know who to contact with questions.
- No special precautions or restrictions are needed for an innocent murmur
- Keep routine childhood vaccinations up to date
- Mention a known innocent murmur to new clinicians so it is not re-investigated unnecessarily
- Seek review if new symptoms such as breathlessness, fainting or chest pain develop
Repeat, follow-on and what comes next
- A murmur may be reassessed at a later visit, especially if first heard during an illness.
- An echocardiogram may need repeating if a young child cannot stay still enough for clear images.
- Occasionally a murmur that seemed innocent is reviewed again if new symptoms develop.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear statement of whether the murmur is innocent or under investigation, ideally in writing
- Plain advice that an innocent murmur places no limit on activity, sport or vaccinations
- A specified plan for any echocardiogram, follow-up, or paediatric cardiology referral
- A list of symptoms that should prompt a fresh assessment
- A named contact for questions and for sharing results
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is a consultation alone or also includes an echocardiogram
- Whether a paediatric cardiologist or a general paediatrician carries out the review
- Whether the scan is reported by a specialist and how quickly
- Whether additional tests (such as an ECG) are needed
- Whether follow-up appointments are required
- Out-of-hours or weekend timing for private appointments
- The clinician's consultation fee
- Whether an echocardiogram is included or charged separately, and who reports it
- The cost of any additional tests such as an ECG
- What is included if follow-up or a repeat scan is needed
- What happens, and what it costs, if referral to paediatric cardiology is required
- How and when you will receive the result and any letter
On the NHS? Assessment of a heart murmur in a child, including an echocardiogram and paediatric cardiology review when clinically needed, is available on the NHS; private review is sometimes used for speed or a second opinion.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Reassurance given without explaining how confident the clinician is, or what would change the picture
- Not being told which symptoms should prompt a fresh assessment
- Over-investigation of a clearly innocent murmur, generating unnecessary anxiety
- Not being told who will interpret the echocardiogram and when the result will come
- Assuming an ECG or X-ray can settle the question when an echocardiogram is the appropriate test
Marketing red flags
- Routine scans or extensive 'cardiac screening' pushed for every childhood murmur regardless of features
- Alarming language that implies a murmur is automatically dangerous
- Promises that one test rules out every possible heart condition for life
- Discouraging use of the NHS paediatric cardiology pathway when it is the appropriate route
- Lack of clear communication about who reports the scan and how results are shared
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Does this murmur have the features of an innocent murmur, and how confident are you?
- Does my child need an echocardiogram, and what will it change?
- Are there any symptoms or signs that would worry you?
- Does our family history affect how you assess this?
- Is any follow-up needed, or can I treat my child completely normally?
- What symptoms should make me seek further advice?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is a heart murmur in my child dangerous?
Does my child need a heart scan?
Is an echocardiogram safe and does it hurt?
Can my child still do sport and PE?
Will the murmur go away?
Can I get this assessed on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Royal Brompton & Harefield (NHS) — Innocent heart murmur in children NHSGGC — Incidental murmur guideline (paediatrics) British Heart Foundation — Heart murmurs NHS — Congenital heart disease
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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