A Child Living with a Pacemaker or Implantable Cardioverter Defibrillator (ICD)
Today's implanted pacemakers and ICDs generally last 8 to 10 years or more,depending on usage and the type of device. In most cases, a child with one of these devices can lead a normal life. New technology has also reduced the interference risk from machinery, such as microwaves. In the past, these items may have affected these devices. Even so, take care when a child has an implanted pacemaker or ICD.
What precautions should be taken with an implanted pacemaker or ICD?
Your child should wear a medical ID bracelet or necklace to let others know about the device in case of emergency. When he or she is old enough to have a wallet, it's a good idea to also carry an ID card.
The following items don't alter the function of today's pacemakers or ICDs:
Kitchen appliances such as blenders, toaster ovens, and electric knives
TVs, TV remote controls, FM and AM radios, and stereos
TV and radio transmitters
Ham radios and CB radios
Electric blankets and heating pads
Electric shavers, hair dryers, curling irons, and other personal care appliances
Gardening machinery, such as electric trimmers
Garage door openers
Metal detectors for consumer use. It's unlikely that security metal detectors will cause harm, but don't let your child stand next to one for long periods.
Copy and fax machines
Correctly grounded shop tools, except power generators or arc welding equipment
Cell phones and MP3 players
Typically, cell phones don't affect pacemakers or ICDs. Most devices made today have a filter that allows the use of most cell phones throughout the world. This includes analog and digital phones. But the Federal Communications Commission (FCC) is making new frequencies available for cell phones, which may make pacemakers or ICDs less reliable. It's generally advised to keep a cell phone at least 6 inches away from a pacemaker or ICD. Also don't carry a cell phone in a breast pocket over the device. Similarly, don't place MP3 players and headphones close to a pacemaker as they may cause some interference.
Make sure your child uses caution when going through security detectors at airports and government buildings, such as courthouses. It's generally safe to go through airport security detectors. They should not damage the pacemaker or ICD. But, tell airport security personnel that your child has a pacemaker or ICD before he or she goes through security. The device may set off the alarm. Also, if your child is selected for a more detailed search, politely remind security that the hand-held metal-detecting wand should not be held over the device for any prolonged period of time (more than a second or two). The magnet inside the detecting wand may temporarily change the operating mode of the device. Be prepared to show an ID card or a medical ID bracelet to pass through security checkpoints.
The following situations may cause interference with pacemakers or ICDs. Some of the activities mentioned are not appropriate until a child nears adulthood, but may affect older teenagers. Discuss the following in detail with your child's doctor:
Don't work with, hold, or carry magnets near the pacemaker or ICD.
Some modern day pacemakers and ICDs aren't affected by MRIs. They usually require some programming changes before the scan. Older models may not be compatible with MRIs so your child should not be given an MRI because it may affect the programming or function of the device. Also, the rapidly changing magnetic field within the MRI scanner may cause heating of the device leads. Often, there are other options to MRI if the child has pacemaker or ICD that is not compatible. If your child's doctor determines that he or she absolutely needs an MRI scan, discuss this thoroughly with your child's cardiologist before proceeding. If the cardiologist and you decide to go ahead, your child should be closely monitored during the scan. A pacemaker programming device should be available right away during the scan.
Don't use heat in physical therapy to treat muscles.
Turn off large motors, such as cars or boats, when working on them, as they may temporarily "confuse" the device. Don't use chain saws, because of the close contact with the motor components.
Stay away from certain high-voltage or radar machines, such as arc welders, high-tension wires, radar installations, smelting furnaces, electric steel furnaces, and other high-current industrial equipment.
Don't work in restricted spaces near radio or TV transmitting towers and antennas.
If your child is having a surgical procedure done by a surgeon or dentist, tell the surgeon or dentist that your child has a pacemaker or ICD. Some surgical procedures will require that your child's device be temporarily turned off or set to a special mode. This decision will be made by your child's cardiologist. Temporarily changing the mode on your child's device can be done without surgery, but should only be done by qualified medical personnel.
Certain medical procedures may sometimes affect the function of the device. They might be done successfully with some changes to the pacemaker or ICD settings. These procedures include:
Extracorporeal shock-wave lithotripsy (ESWL). A procedure that dissolves kidney stones.
Transcutaneous electrical nerve stimulation (TENS). A device used to ease acute or chronic pain.
Therapeutic radiation treatments for cancer
Talk with your child's doctor before your child undergoes these procedures.
Always consult your child's doctor if you have any questions concerning the use of certain equipment near your child's pacemaker.
Can my child do regular daily activities with a pacemaker or ICD?
Once the device has been implanted and the initial post operative period has been completed (3 to \\-4 weeks), your child should generally be able to do the same activities as other children in the same age group. Your child's doctor will provide activity instructions specific to your child and their underlying health condition.
But no matter the sport or activity, the child should prevent getting a blow to the area over the pacemaker or ICD..A blow to the chest or abdomen near the pacemaker or ICD can affect how it functions. Contact sports are usually not advised for children with pacemakers or ICDs for this reason. If your child does get a blow to that area, contact your child's doctor. Ask your child's doctor about activity limits.
Always talk with your child's doctor when he or she feels ill after an activity, or when you have questions about starting a new activity.
How can I ensure that my child's pacemaker or ICD is working correctly?
Although your child's device is built to last 8 to 10 years, have it checked regularly to ensure that it is working correctly. Different doctors may have different schedules for checking devices. Most can be checked remotely (in the home) using a telephone and special equipment provided by your child's device manufacturer. Your child's doctor will recommend in-person device checks at specific intervals as well. Any device setting changes must be made in person, by a trained medical professional, using a device programmer.
Battery life, lead wire condition, and various functions are checked by doing what is called "device interrogation". During an interrogation, the device is connected to a device programmer using a special wand placed on the skin over the pacemaker or ICD. The data is sent from the device to the programmer and assessed. Most in-home device interrogation systems use wireless technology to connect the device to special equipment. The equipment records the data and sends the information to your child's doctor.
Your doctor may ask you to check your child's pulse rate periodically. Report any unusual symptoms, or symptoms similar to those your child had before the device insertion, to your child's doctor immediately.
Always talk with your child's doctor for more information, if needed.
What is the pulse?
The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. This can be felt in various points in the body as a pulse. Taking a pulse measures the heart rate and the following:
Heart rhythm. An abnormal rhythm may mean a heart disorder or arrhythmia.
Strength of the pulse. A weak pulse may mean a fast heartbeat in which some beats are too weak to feel, heart failure, or a low volume of blood in the circulatory system.
Many pacemakers provide varying rates, depending on your child's activity level and other factors. The pulse rate may change and increase with exercise, illness, injury, and emotions. Teen girls and women, in general, tend to have faster heart rates than do boys and men of the same age. Athletes, such as runners, who do a lot of cardiovascular conditioning may have naturally slow heart rates.
How to check your child's pulse
As the heart forces blood through the arteries, you can feel the beats by firmly pressing on an artery. Your arteries are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the lower neck, on the inside of the elbow, or at the wrist. When taking a pulse:
Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse. Do not use your thumb to feel for the pulse.
Start counting the pulse when the clock's second hand is on the 12.
Count the pulse for 60 seconds (or for 15 seconds and then multiply by 4 to calculate beats per minute).
When counting, don't watch the clock continuously, but concentrate on the beats of the pulse. If you have trouble with this method, try a digital kitchen timer and set it for 1 minute. Stop counting when the timer alarms.
If unsure about your results, ask another person to count for you.
It may be better to check the wrist (radial artery) pulse than a neck (carotid artery) pulse. If you must check a neck pulse, don't press hard on the neck, and never press on both sides of the neck at the same time; this can cause some people to pass out from cutting off blood supply to the brain.
If you are having trouble finding your child's pulse, consult your child's doctor for instruction.
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