Innocent murmurs — when to ask a cardiologist

One in five infants and children at any one time will have a systolic murmur if examined carefully. One in two children will be heard to have a murmur at some stage, particularly in association with a febrile illness. Very few paediatricians in the UK now will recall the days when the finding of such a murmur required a careful evaluation for any history or clinical signs suggestive of rheumatic fever, but all will be aware that about one child in 100 is born with some form of congenital heart disease, many of whom are first diagnosed by the finding of a cardiac murmur. The remainder of the children with murmurs will have no cardiac disease and the murmur will be labelled as innocent or functional. The former term is now the preferred one.