• Is Your Child’s Murmur Normal or Abnormal?

    If your child has a heart murmur, your child’s doctor will need to determine if the murmur is normal (innocent) or abnormal (pathologic).

    Learning About Your Child’s Health

    Often assessment of a heart murmur includes obtaining information about your child’s health. The doctor will ask you questions. Your answers to these questions may help determine if the murmur is abnormal. Your doctor may ask questions such as:
    • Did you notice any problems, such as rapid breathing or a blue or pale gray skin color?
    • Does your child eat well?
    • Does your child show signs of easy tiredness or shortness of breath?
    • When was the murmur first heard?
    • How has your child been gaining weight?

    Physical Examination: Looking for Signs of Heart Disease

    If your answers suggest an abnormal heart murmur, the doctor will examine your child for signs of heart disease. These signs might include:
    • Evidence of congested lungs or enlarged liver
    • Swelling of the feet, ankles and legs
    • Bluish discoloration of the skin and low oxygen levels

    Grading the Heart Murmur

    The doctor will listen to and assess the heart murmur.

    Systolic murmurs are graded on a scale from 1 to 6, with louder murmurs assigned larger numbers. Murmurs from 4 to 6 can be felt as well as easily heard with a stethoscope. They are always considered to be abnormal (pathologic) unless proven otherwise.

    Diastolic murmurs are graded on a scale from 1 to 4. Unlike systolic murmurs, all diastolic murmurs are considered to be pathologic unless proven otherwise. Continuous murmurs are considered to be abnormal unless proven otherwise as well.


    Tests, such as an electrocardiogram (ECG), chest x-ray or echocardiogram, may be performed to confirm the presence or absence of heart disease.

    You can learn more about these and other tests here.