When Your Child Has Infective Endocarditis (IE)

Infective endocarditis (IE) is an infection of the lining of the heart or heart valves. It used to be known as bacterial endocarditis because most commonly it's caused by a bacterial infection. IE can cause serious damage to the heart. For this reason, it must be treated right away. If your child has a heart problem, be sure to check with his or her healthcare provider about how to prevent this infection.

Four chamber view of the heart showing the endocardium.

Who is at risk for IE?

IE can occur in any child but is not very common. The risk is increased if a child has certain heart problems. These include:

  • An abnormal or damaged heart valve

  • A problem heart valve that has been replaced with an artificial valve

  • Certain congenital (present at birth) heart defects that have not been repaired 

  • Repaired heart problems (for 6 months after surgery, or sometimes longer) 

  • Previous endocarditis

  • Significant infection in combination with any of the above. 

What causes IE?

IE occurs when bacteria enter the bloodstream and become attached to the heart. A child with a heart problem is more likely to have areas in the heart that can get easily infected. The most common ways bacteria can enter the bloodstream are through certain dental and medical procedures. They can also enter the bloodstream through infections in other parts of the body, especially if not treated in a timely manner, or if your child has a weak immune system.

What are the symptoms of IE?

Symptoms of IE vary for each child and many children may not have any specific symptoms. Symptoms can include:

  • Rash

  • Tiredness (fatigue)

  • Weight loss

  • Blood in the urine

  • Joint pain or arthritis 

  • Muscle aches and pain

  • Heart palpitations

  • Irritability

  • Fevers that come and go

How is IE diagnosed?

If IE is suspected, your child will likely be referred to a doctor called a pediatric cardiologist.  This is a doctor with special training to diagnose and treat heart problems in children. The doctor will ask about your child’s health history and symptoms. The doctor will also examine your child. Tests are often done as well. These can include:

  • Blood tests. Several blood samples are taken within 24 hours. These are checked for bacteria.

  • Echocardiogram (echo). Sound waves (ultrasound) are used to create a picture of the heart. This lets the doctor to check for signs of infection and problems with heart structure and heart function. This can be done by passing a probe over the chest where the heart is located (transthoracic). Or it may be done by passing a tiny probe down the esophagus to get a closer view of the heart (transesophageal).

How is IE treated?

  • Treatment for ID is antibiotics given through an IV line. This may be needed for as long as 6 weeks, but is dependent on the type of bacteria causing the infection and the specific location of the infection within the heart. Treatment is started in the hospital. But it may be completed in the hospital or at home. Blood tests are done during the course of the treatment. These help ensure the infection is no longer in the bloodstream and can evaluate for adverse effects of the antibiotics being used.

  • In certain cases, your child may need surgery. Your child’s doctor will tell you more about this treatment, if needed.

How is IE prevented?

  • Know the signs and symptoms of IE. Tell your child’s doctor right away if you suspect your child is ill due to IE.

  • Teach your child good oral hygiene. Make sure your child brushes and flosses daily. Also, schedule regular teeth cleanings for your child.

  • Tell all of your child’s healthcare providers that your child is at risk for IE. Your child may need to take antibiotics before and after certain dental or medical treatments are done. This helps reduce the risk of infection.

When should I call my child's healthcare provider?

Unless advised otherwise by your child’s healthcare provider, call the provider right away if:

  • Your child has a fever (see Fever and children, below)

  • Your baby is fussy or cries and can't be soothed.

  • Your child has a fever that comes and goes.

Also call your child's healthcare provider if your child has any of the following:

  • Chest pain

  • Shortness of breath

  • Severe pain in the belly, lower back, or side

  • Blood in the urine

  • Heart palpitations

  • Unexplained fatigue

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Baby under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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