The physical and mental development of children with congenital heart disease

Abstract

Some aspects of the physical and mental development of 400 children with congenital heart disease, mainly cyanotic, have been discussed, and 200 cases where the data were complete have been analysed more fully as regards their height and weight. Fallot's tetralogy was the diagnosis made most commonly; this, or some closely related lesion, was present in nearly half of all the cases, and in two-thirds of those who were cyanotic. The children were, on the whole, slightly below the expected height for their age, and the average figure was 96 per cent. of the normal. This means that a child of one year was more than 1 in. below, and a young adult 2 1/2 in. below, the average. The weight was much more below standard than the height so that the children looked thin, and the average figures was as low as 85 per cent, of the expected normal. Eight-tenths of them were more than 2 lb. below the average weight and only one-tenth were this amount above it. Comparison of the height and weight showed that they were below the expected weight for their height as well as below the expected weight for their age. Both as regards height and weight, those who had severe cyanosis were more below the expected level than those who had moderate cyanosis, and still more below those who were acyanotic. Those who were diagnosed as cases of Fallot's tetralogy were less below height and weight than the other comparably cyanotic cases. The ages of walking and talking were taken as measures of their general development. There was some delay among the cyanotic cases and only 73 per cent. of them were walking by the age of two years. When there was severe cyanosis that dated from birth less than half (47 per cent.) were walking by the age of two years; but great delay was not found, and where children are not walking by the age of three years other causes must be looked for. There was less delay in the age of talking, but here, too, among those who had been severely cyanosed from birth, a smaller proportion were talking by eighteen months, though by two years of age this delay had almost been overcome. We thought that the mental capacity of these children was normal and well up to the average, though many were educationally backward. There were 4 per cent, who were defective, a larger proportion than among children in general, but, partly because of the good normal development of the others, we think this was a second associated defect rather than a direct effect of the cyanosis and anoxaemia. Among these cases there were five mongols and four of them were cyanotic, though auricular septal defects, which do not as a rule produce cyanosis, are recognized as the commonest congenital heart defect in mongols. Some chest deformity was present in many of these children; about 15 per cent. showed pigeon chest, 15 per cent. Harrison's sulcus, and 15 per cent. some prominence of the ribs, generally on the left side. Scoliosis was not uncommon and was occasionally severe, and this and some other deformities of posture had often been made worse by squatting.