A Child Living with a Pacemaker or Implantable Cardioverter Defibrillator (ICD)

What safety steps should be taken with an implanted pacemaker or ICD?

Your child should wear a medical ID bracelet or necklace. This is to let others know about the device in case of emergency. When your child is old enough to have a wallet, they should also carry an ID card.

The following items don't affect the function of today's pacemakers or ICDs:

• Microwave ovens

• Kitchen appliances such as blenders, toaster ovens, and electric knives

• TVs, TV remote controls, FM and AM radios, and stereos

• TV and radio transmitters

• Ham radios and CB radios

• Electric blankets and heating pads

• Electric shavers, hair dryers, curling irons, and other personal care appliances

• Gardening machinery, such as electric trimmers

• Garage door openers

• Metal detectors for consumer use. It's unlikely that security metal detectors will cause harm, but don't let your child stand next to one for long periods.

• Computers

• Copy and fax machines

• Correctly grounded shop tools, except power generators or arc welding equipment

Cellphones and electronic devices

Have your child use caution when around cellphones and other electronic devices. Keep them at least 6 inches away from your child's pacemaker or ICD.

It's safest for your child to hold their cellphone to the ear farthest from their pacemaker or ICD. Or to use the speaker mode setting. Don’t have your child carry a phone or electronic device in a chest pocket, over the pacemaker or ICD. Experts advise that your child should carry cellphones and other electronics in a pocket or bag below their waist.

Most cellphones and electronic devices don't interfere with pacemakers or ICDs. But some of them, such as smart watches, use powerful magnets for wireless charging. These magnets may interfere with the normal function of your child's pacemaker or ICD. The magnet used for charging or other magnet accessories can also interfere with the normal function of the pacemaker or ICD. These devices should be kept away from your child's pacemaker or ICD when charging wirelessly or being stored.

Follow any other instructions given to you by your child's healthcare provider or from the maker of the pacemaker or ICD.

Security

Make sure your child uses caution when going through security detectors at airports and government buildings, such as courthouses. It's generally safe to go through airport security detectors. They should not damage the pacemaker or ICD. But tell airport security staff that your child has a pacemaker or ICD before they go through security. The device may set off the alarm.

If your child is selected for a more detailed search, politely remind security that the handheld metal-detecting wand should not be held over the device for more than 1 or 2 seconds. The magnet inside the detecting wand may briefly change the operating mode of the device.

Tell your child to be ready to show an ID card or a medical ID bracelet to pass through security checkpoints.

Other safety steps

Certain situations may cause interference with pacemakers or ICDs. Below are important safety steps to take. Some of the things listed below may only affect older teens. Discuss these in detail with your child's healthcare provider:

• Don't work with, hold, or carry magnets near the pacemaker or ICD.

• Some modern-day pacemakers and ICDs aren't affected by MRIs. They often need some programming changes before the scan. Older models may not be compatible with MRIs. So your child should not be given an MRI because it may affect the programming or function of the device. Also, the rapidly changing magnetic field within the MRI scanner may cause heating of the device leads. Often there are other options if the child has a pacemaker or ICD that is not MRI-compatible. If your child's provider finds that they absolutely need an MRI scan, discuss this with your child's cardiologist before going ahead. If the cardiologist and you decide to go ahead, your child should be closely watched during the scan. A pacemaker programming device should be available right away during the scan.

• Don't use heat in physical therapy to treat muscles.

• Turn off large motors, such as cars or boats, when working on them. They may briefly "confuse" the device. Don't use chain saws. This is because of the close contact with the motor parts.

• Stay away from certain high-voltage or radar machines. These include arc welders, high-tension wires, radar installations, smelting furnaces, electric steel furnaces, and other high-current industrial equipment.

• Don't work in restricted spaces near radio or TV transmitting towers and antennas.

• If your child is having surgery done by a surgeon or dentist, tell them that your child has a pacemaker or ICD. For some procedures, your child's device may need to be turned off briefly. Or set to a special mode. This decision will be made by your child's cardiologist. Briefly changing the mode on your child's device can be done without surgery. But it should be done only by qualified medical staff.

Certain medical procedures may sometimes affect the function of the device. They might be done successfully with some changes to the pacemaker or ICD settings. These procedures include:

• Extracorporeal shock-wave lithotripsy (ESWL). A procedure that dissolves kidney stones.

• Transcutaneous electrical nerve stimulation (TENS). A device used to ease acute or chronic pain.

• Therapeutic radiation treatments for cancer

Talk with your child's healthcare provider before your child has these procedures.

Always consult your child's provider if you have any questions about the use of certain equipment near your child's pacemaker.

Can my child do regular daily activities with a pacemaker or ICD?

Once the device has been implanted and the early post-operative period is over (3 to 4 weeks), your child should generally be able to do the same activities as other children their age. Their healthcare provider will provide activity instructions. These will be specific to your child and their underlying health condition.

But no matter the sport or activity, it's key to avoid getting a direct hit in the area over the pacemaker or ICD. A hit to the chest or belly (abdomen) near the pacemaker or ICD can affect how the device works. For this reason, contact sports are often not advised for children with pacemakers or ICDs. If your child does get hit in that area, contact their provider. Ask the provider about activity limits.

Always talk with your child's provider when they feel ill after an activity. Or when you have questions about starting a new activity.

How can I ensure that my child's pacemaker or ICD is working correctly?

Your child's device is built to last 8 to 10 years. But it's important to have it checked regularly to ensure that it is working correctly. Different healthcare providers may have different schedules for checking devices. Most can be checked remotely (in the home). This is done using a phone and special equipment provided by the device manufacturer. Your child's provider will advise in-person device checks at certain times as well. Any device setting changes must be made in person, by trained medical staff, using a device programmer.

Battery life, lead wire condition, and various functions are checked by doing what is called device interrogation. During an interrogation, the device is connected to a device programmer. This is done using a special wand placed on the skin over the pacemaker or ICD. The data is sent from the device to the programmer and assessed. Most in-home device interrogation systems use wireless technology to connect the device to special equipment. The equipment records the data. It sends the information to your child's provider.

The provider may ask you to check your child's pulse rate from time to time. Report any abnormal symptoms, or symptoms similar to those your child had before the device insertion, to your child's healthcare provider right away.

Always talk with your child's healthcare provider for more information, if needed.

What is the pulse?

The pulse rate is a measurement of the heart rate, or the number of times the heart beats per minute. As the heart pushes blood through the arteries, the arteries expand and contract with the flow of the blood. This can be felt in various points in the body as a pulse. Taking a pulse measures the heart rate and the following:

• Heart rhythm. An abnormal rhythm may mean a heart disorder or arrhythmia.

• Pulse strength. A weak pulse may mean a fast heartbeat in which some beats are too weak to feel, heart failure, or a low volume of blood in the circulatory system.

Many pacemakers provide varying rates, depending on your child's activity level and other factors. The pulse rate may change and increase with exercise, illness, injury, and emotions. In general, teen girls and women tend to have faster heart rates than boys and men of the same age. Athletes who do a lot of cardiovascular conditioning, like runners, may have naturally slow heart rates.

How to check your child's pulse

As the heart forces blood through the arteries, you can feel the beats by firmly pressing on an artery. Your arteries are located close to the surface of the skin at certain points of the body. The pulse can be found on the side of the lower neck, on the inside of the elbow, or at the wrist. When taking a pulse:

• Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse. Don't use your thumb to feel for the pulse.

• Start counting the pulse when the clock's second hand is on the 12.

• Count the pulse for 60 seconds (or for 30 seconds and then multiply by 2 to calculate beats per minute).

• When counting, don't watch the clock continuously. Focus on the beats of the pulse. If you have trouble with this method, try a digital kitchen timer and set it for 1 minute. Stop counting when the timer alarms.

• If you are unsure about your results, ask another person to count for you.

• It may be better to check the wrist (radial artery) pulse than a neck (carotid artery) pulse. If you must check a neck pulse, don't press hard on the neck. And never press on both sides of the neck at the same time. This can cause some people to pass out from cutting off blood supply to the brain.

If you are having trouble finding your child's pulse, contact their provider for instructions.