[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Nursing the child with congenital heart disease: feeding, hypercyanotic spells, heart failure and catheterisation

# Nursing the child with congenital heart disease: feeding, hypercyanotic spells, heart failure and catheterisation

- Safe practice

Babies with heart defects tire while feeding and can turn blue or develop heart failure; the nurse watches growth, breathing and colour and teaches the family.

Updated Nov 13, 2026

## Key points

- Breast milk is the best nutrition for infants with heart disease; energy-dense feeds and tube feeding are used when the team prescribes them.
- Heart failure signs in infants: fast or hard breathing, sweating while feeding, pallor, fast heart rate, faltering weight, frequent chest infections.
- Cyanotic spell: bring the knees up to the chest, calm the child and get medical help immediately.
- After catheterisation: check the insertion site for bleeding and the limb below it for colour, warmth and feeling.
- Feeding intolerance (distended abdomen, bloody stools, bilious vomiting) can signal gut ischaemia: report at once.

## What it is

Many infants with congenital heart disease breathe fast and have a fast heart rate, so they burn more energy and tire during feeds. Growth is often the first thing to suffer. The nurse supports feeding, weighs the baby and records intake and output, recognises signs of heart failure, knows what to do in a cyanotic (tet) spell and cares for the child after cardiac catheterisation or surgery. The family learns the warning signs before going home.

## What it requires

- Daily weight, accurate intake and output, and growth plotted over time.
- Respiratory rate, heart rate, colour and SpO2 compared with the child's own baseline.
- Feeding plan set by the cardiology and nutrition team.
- Family teaching on warning signs and when to call.

## How it is applied (and why)

- Weigh daily on the same scale and record intake and output — weight and balance show both growth and fluid retention.
- Watch the baby feed: time, breathing rate, sweating, colour, pauses — fatigue during feeds is a key sign of a failing heart.
- Offer the feeding plan as ordered and report if the baby cannot finish — tube feeding may be needed to meet energy needs.
- Check SpO2, heart rate and breathing against the target the cardiology team set — targets differ between defects.
- In a cyanotic spell: knees to chest, calm the child, give oxygen per protocol and call for help — this raises lung blood flow.
- Avoid long crying and distress where possible; group care — cyanosis gets worse when these babies are upset.
- After catheterisation, check site, distal pulses, colour and warmth of the limb as ordered — these are the complications to catch.
- If the site bleeds, apply firm pressure and call — pressure controls most site bleeding.
- Teach the family the warning signs and the follow-up plan before discharge — regular cardiology follow-up watches for heart failure.

## In nursing practice

- Small defects may cause no symptoms; large ones can cause heart failure in the first months.
- Children on diuretics need blood tests for electrolytes, per order.
- After heart surgery, call for fever, breathing difficulty, bluish or grey skin, puffy eyes or face, constant tiredness or feeding problems.
- Contact the team if the baby has trouble breathing or an unusual number of chest infections.

## Common mistakes

- Pushing a tired baby to finish the bottle instead of reporting the fatigue.
- Judging saturation against adult targets instead of the target the cardiologist set for this child.
- Missing slow weight gain because weights are not plotted.
- Not teaching the family what to do if the child turns blue.

## Test yourself

Think of the answer, then tap the question to see it.

## Why do infants with congenital heart disease often grow poorly?

Fast breathing and heart rate raise energy needs while the baby tires during feeds and takes less.

## What should a caregiver do if a child with tetralogy of Fallot turns blue?

Bring the knees up to the chest, calm the child and get medical help immediately.

## Which signs suggest heart failure in an infant?

Fast or hard breathing, sweating while feeding, pallor, fast heart rate, faltering weight and frequent chest infections.

## What does the nurse check after cardiac catheterisation?

The insertion site for bleeding, and the limb below it for pulses, colour, warmth and feeling.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/nursing-the-child-with-congenital-heart-disease-feeding-hypercyanotic-spells-hea/)

## Connections

## Related 2

- [Cardiac monitoring at the bedside: leads, alarms and rhythm changes to report](https://durgical.com/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/)
- [Fluid balance: recording intake and output](https://durgical.com/en/nursing/fluid-balance-recording-intake-and-output/)

## Related conditions 8

- [Tetralogy of Fallot](https://durgical.com/en/conditions/tetralogy-of-fallot/)
- [Ventricular septal defect](https://durgical.com/en/conditions/ventricular-septal-defect/)
- [Atrial septal defect](https://durgical.com/en/conditions/atrial-septal-defect/)
- [Patent ductus arteriosus](https://durgical.com/en/conditions/patent-ductus-arteriosus/)
- [Coarctation of the aorta](https://durgical.com/en/conditions/coarctation-of-the-aorta/)
- [Hypoplastic left heart syndrome](https://durgical.com/en/conditions/hypoplastic-left-heart-syndrome/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Kawasaki disease](https://durgical.com/en/conditions/kawasaki-disease/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Feeding Approach to Optimizing Nutrition in Infants with Congenital Heart Disease (Chan B, Woodbury A, Hazelwood L, Singh Y), J Cardiovasc Dev Dis](https://europepmc.org/article/PMC/PMC11856444) (Europe PMC (open access), 2025); [Tetralogy of Fallot](https://medlineplus.gov/ency/article/001567.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Ventricular septal defect](https://medlineplus.gov/ency/article/001099.htm) (MedlinePlus, U.S. National Library of Medicine, 2024); [Pediatric heart surgery - discharge](https://medlineplus.gov/ency/patientinstructions/000015.htm) (MedlinePlus, U.S. National Library of Medicine, 2024).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/nursing/nursing-the-child-with-congenital-heart-disease-feeding-hypercyanotic-spells-hea/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/nursing-the-child-with-congenital-heart-disease-feeding-hypercyanotic-spells-hea/