EKG in Children

Aka: EKG in Children, Electrocardiogram in Children, Pediatric EKG

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II. Approach

  1. General
    1. Children age >10 years old have EKGs similar to adults
  2. Right Axis Deviation
    1. Normal finding in infants age <6 months
    2. Right Axis Deviation is typically abnormal after age 6 months
      1. See Right Axis Deviation
      2. Right Ventricular Hypertrophy
      3. Congenital Heart Disease
  3. P Waves
    1. P Waves should be upright (as with adults)
    2. Inverted P Waves may suggest ectopic focus (e.g. ectopic Atrial Tachycardia)
  4. T Wave Inversion
    1. T Waves are upright in V1 for the first week of life
      1. After week 1, T Waves invert in V1 and remain inverted
      2. Persistent upright T Waves in V1 may indicate Right Ventricular Hypertrophy
    2. T Waves may be inverted in general up to age 3 to 8 years
      1. After age 3 to 8 years, T Waves are upright and remain upright into adulthood
      2. Children who have had upright T Waves on prior EKG, should continue to have upright T Waves

III. Resources

  1. Normal paediatric ECG (Burns and Butner, Life in the Fastlane)
    1. https://litfl.com/normal-paediatric-ecg/
  2. Basic Paediatric ECG interpretation (Royal Children's Hospital Melbourne)
    1. https://www.rch.org.au/clinicalguide/guideline_index/Basic_Paediatric_ECG_interpretation/

IV. References

  1. Johnson and Lu (2025) Pediatric Pearls: Pediatric EKG, EM:Rap, 1/20/2025

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