Management of asymptomatic heart murmurs in infants and children

Murmurs heard in neonates and older children may be innocent or signify heart disease. The neonatologist or general paediatrician must decide which infants and children need specialist referral, and if so, the urgency of referral. Neonates with clinical features suggesting heart disease should be referred urgently. Neonates with murmurs and no other pathological features must be reviewed regularly during the first few weeks of life if they are not referred to a cardiologist. Older children with asymptomatic murmurs should be referred routinely to a cardiologist if the paediatrician or parents are concerned about the possible significance of the murmur.