Can children or teens have pacemakers or ICDs? 

Yes, children and teenagers can have pacemakers or implantable cardioverter defibrillators. While we often associate these devices with older adults, they are vital for younger patients with congenital heart defects, inherited heart rhythm disorders, or conduction issues that appear after heart surgery. Providing a cardiac device to a child requires a specialized pediatric cardiology team to manage the unique challenges of a growing body and an active lifestyle. 

In this article, you will learn about the clinical indications for devices in the pediatric population, the different surgical techniques used for infants versus teens, and how families can support a young person in returning to school and physical activities. 

What we’ll discuss in this article 

• Whether children and teenagers can safely have pacemakers or ICDs 

• The main medical reasons pediatric patients may need cardiac devices 

• Differences in implantation techniques for infants, children, and teens 

• What to expect during recovery and long-term follow-up 

• Returning to school, social life, and emotional well-being 

• Sports participation, activity restrictions, and protective options 

• The role of remote monitoring and ongoing pediatric cardiology care 

Why children require cardiac devices 

The most common reason for a child to receive a pacemaker is a congenital heart block, where the electrical signal from the top to the bottom of the heart is delayed or blocked from birth. Other indications include sick sinus syndrome, often seen after complex surgery for congenital heart disease, or conditions like Long QT Syndrome and Brugada Syndrome that increase the risk of dangerous fast heart rhythms. 

For teenagers, an ICD is more frequently used to prevent sudden cardiac death if they are diagnosed with a cardiomyopathy or a genetic arrhythmia. These devices act as a constant monitor, ready to deliver a life saving shock if the heart enters a lethal rhythm. The decision to implant is always based on a thorough clinical risk assessment by an electrophysiologist. 

• Congenital heart block and other birth related conduction issues. 

• Heart rhythm disorders following surgical repair of heart defects. 

• Inherited conditions like cardiomyopathy that require sudden death prevention. 

• Severe fainting episodes related to a dangerously slow heart rate. 

Surgical techniques for younger patients 

The way a device is implanted depends largely on the size and weight of the child. For infants and very small children, a transvenous approach through the veins is often not possible because the veins are too narrow. In these cases, we use an epicardial approach, where the leads are placed on the outside surface of the heart and the generator is tucked into a pocket in the abdomen. 

As children grow into their teenage years and their veins become larger, we typically switch to the standard transvenous approach used in adults. The generator is placed in a pocket just below the collarbone, and the leads are guided through a vein into the heart. This transition often happens during a routine battery replacement as the child matures. 

• Epicardial placement: Best for infants and small children, generator in the abdomen. 

• Transvenous placement: Standard for older children and teens, generator in the shoulder. 

• Leads are often implanted with extra loops to account for future growth. 

• General anesthesia is almost always used for pediatric device procedures. 

Life at school and peer support 

Returning to school is a major milestone for a child with a new device. It is essential for parents to meet with school staff to discuss the clinical safety of the device. Most school activities are perfectly safe, but teachers should be aware of the implant to help the child avoid direct impact to the chest during play or PE. 

Teenagers may face psychological challenges, such as feeling different from their peers or worrying about the appearance of the surgical scar. Encouraging open communication and connecting with support groups can help young people navigate the emotional side of living with a cardiac device. Most teens find that after the initial recovery, they can participate in almost all school events and social activities. 

• Inform school nurses and PE teachers about the device location and safety. 

• Ensure the child carries their medical ID card or wears a medical alert bracelet. 

• Support groups for heart kids can help with body image and confidence. 

• Most school based electronics and Wi Fi are safe and do not interfere. 

Sports and physical activity 

One of the most frequent questions from parents and teens is whether they can still play sports. Clinical guidelines encourage children to be active to keep their hearts healthy. After the initial six week healing period, most non contact sports like swimming, tennis, and golf are highly recommended. 

However, high impact contact sports like rugby, boxing, or martial arts are generally discouraged due to the risk of a direct blow to the generator or the leads. If a teen is passionate about a specific sport, specialist protective shields can often be worn to minimize the risk. The goal is to balance the physical well being with the need to participate in the activities they love. 

• Non contact sports are safe and beneficial after the initial recovery. 

• Contact sports require a detailed discussion with the cardiology team. 

• Protective gear and chest shields can offer extra security for active kids. 

• Avoid activities that involve hanging by the arms during early healing. 

Remote monitoring and follow up 

Pediatric devices are monitored closely through a combination of in person clinic visits and remote home monitoring. A small transmitter kept by the child’s bed can send data to the hospital, allowing the cardiology team to track the device’s battery life and lead function without the child missing school for an appointment. 

These checks are vital as the child grows, as their heart rate needs may change or the leads may require adjustment. Modern devices for children are designed to last between eight and ten years, but regular clinical reviews ensure that a battery replacement can be planned well in advance. 

• Remote monitoring reduces the frequency of hospital visits for busy families. 

• Annual or bi-annual in person checks are required for comprehensive testing. 

• Clinical staff can adjust pacing rates to match a growing child’s needs. 

• Battery life is monitored carefully to plan for future minor procedures. 

Conclusion 

Pacemakers and ICDs are life changing technologies for children and teens, allowing them to lead active and fulfilling lives. While the initial diagnosis and surgery can be a stressful time for families, the long term outcomes for pediatric device patients are excellent. By following clinical advice on activity levels and maintaining regular follow ups, young people with cardiac devices can reach their full potential and transition successfully into adult cardiac care. 

If your child experiences a sudden collapse, extreme dizziness, or if their ICD delivers a shock, seek emergency medical help immediately. 

Authority Snapshot  

This article was written by Dr. Rebecca Fernandez, a UK trained physician with an MBBS and extensive experience in cardiology, general surgery, and intensive care. Dr. Fernandez has a deep interest in the long term well being of pediatric patients and has supported families through the clinical journey of cardiac device management within the NHS. This guide is based on the latest standards from the British Heart Rhythm Society and NICE.