Some children with heart problems are at risk for developing a serious infection called infective endocarditis (IE). This condition was previously known as subacute bacterial endocarditis or bacterial endocarditis.
What is infective endocarditis?
IE is a serious infection of the heart. It is caused by germs such as bacteria and fungi. These germs may get into child's blood in different ways, such as:
- from an operation
- through invasive medical procedures
- through very deep cuts from an accident
- from having work done on the teeth
Usually, a child's body fights the bacteria and they do not get sick. However, if the blood does not flow through your child's heart or valves smoothly, your child may get IE. The chance of your child getting IE is low. However, because IE can be serious, it is important that you and your child know how to prevent it.
The signs of infective endocarditis are similar to the flu
The signs of IE are like the signs of flu. This can make it hard to know if your child has IE. Take your child to the doctor if they have some of these signs and they do not go away.
- a slight fever of 37.5°C to 38.5°C that you cannot explain and that lasts for five to seven days
- sweating
- loss of appetite
- pain in the muscles and joints, such as the knees, shoulders or knuckles
- loss of weight
- a skin rash
- headaches
- a general feeling of weakness
A doctor will test your child for infective endocarditis
There are several tests that can help the doctors find out if your child has IE. These tests are:
- blood tests to check for bacteria; your child may need to have several blood samples taken at different times
- a urine test, which tests your child's urine (pee) for bacteria
- an echocardiogram, which is a recording of the positions and movement of the walls of the heart or the parts inside the heart, such as the valves
Treating infective endocarditis with antibiotics
If your child has IE, the doctor will give them antibiotics, which are medicines that kill germs. These antibiotics will be given to your child through an intravenous tube (IV). An IV is a small tube that is put in a vein in an arm or leg.
Your child may need antibiotics for six weeks or longer. If your child needs antibiotics for a long time, they will have to stay in the hospital for the first few days or weeks. Your child may be able to finish receiving the antibiotics at home with the support of nurses from a service called Community Care Access.
Preventing infective endocarditis with three steps
Remember, it is much better and easier to prevent IE than to treat it. You can help protect your child from IE by taking these three simple steps:
1. Take good care of your child's teeth.
Babies and young children can get very serious tooth decay, called Nursing Bottle Syndrome. This decay may require treatments that put your child at risk of getting IE. To avoid tooth decay, do the following:
- Start early. Get your baby used to having a clean mouth. Wipe your baby's gums gently with a damp face cloth after every feeding. This will help your baby get used to having the gums touched, and the gums will become less sensitive.
- You should start wiping the teeth as soon as your baby gets them. This starts when your baby is about six months old. Usually, you can use a toothbrush to clean your baby's teeth when they are one year old.
- Do not let your baby or child sleep with a bottle of milk or juice. A bottle of water is OK because it does not have sugar that can cause cavities. Breastfeeding or bottle-feeding on demand, which means when your baby wants it, can also cause cavities. So, you should also clean your baby's teeth after you breastfeed or bottle-feed your baby.
- If your baby usually falls asleep right after the last breastfeeding or bottle-feeding, make sure you clean your child's teeth just before you give your baby this last feeding.
- Do not use toothpaste to clean your child's teeth until your child is two years old. You can use infant toothpaste with very little fluoride. Fluoride is a mineral in toothpaste that helps keep the teeth healthy.
- When your child is two to six years old, they should use toothpaste only in very small amounts. Or they should use a toothpaste with little fluoride. Your young child needs only a little fluoride. Too much fluoride may harm your child's permanent teeth.
- Make sure your child brushes their teeth after every meal and snack. Your child should also brush the teeth after taking liquid medicine. Liquid medicine may have a lot of sugar that needs to be cleaned away.
- When your child's back teeth touch each other, get your child to start flossing their teeth. Your child will need help flossing until they get used to doing it. Make sure your child flosses the teeth that touch each other. A toothbrush cannot clean between these teeth. During a visit to the dentist's office, ask the dentist to show your child how to floss properly.
- Take your child to the dentist for regular check-ups starting when your child is six months old.
2. Make sure your child takes antibiotics for any treatment that may cause them to get infective endocarditis.
Some children with heart problems will always need to take antibiotics before getting treatments that could cause IE.
Your child may need to take antibiotics before some dental procedures to prevent infective endocarditis. These dental procedures may include having a tooth taken out, teeth cleaning or fillings near the gums.
Your child's cardiologist or nurse will tell you if your child needs antibiotics. If you are not sure if your child needs antibiotics, ask your child's doctor or nurse.
In 2007, new guidelines were published that explain who needs antibiotics before treatments. These guidelines are available on the American Heart Association website.
3. Get your child a Medic Alert bracelet, if needed.
Your child may need a Medic Alert bracelet that lets a doctor know what special treatment your child may need in an emergency. Ask your child's cardiologist if you should get your child a Medic Alert bracelet.
At SickKids
Our dentists at SickKids like children to visit the dentist first when they are six months old. The dental clinic at SickKids is available for the dental care of some children with special needs up until the age of 18 years.