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Dr. Alessandro Giardini
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When a child is assessed for whatever reason, it is a common occurrence that the heart beat can be irregular. In some children this is due to the presence of ectopic heart beats. It is important to remember that ectopic beats are extremely common in children, and on their own they do not necessarily imply anything is seriously wrong.
An ectopic beat is simply an extra heartbeat that starts slightly early, from a spot in the heart other than its usual pacemaker. Some children describe it as a flutter or a thump, or say their heart "skipped." Most don't feel anything at all, and the beat is only spotted because a test happened to be running at the time. Ectopic beats from the upper chambers are called premature atrial contractions, and from the lower chambers, premature ventricular contractions. Both are common findings on a routine ECG or on a Holter monitor, which records the heart over a longer stretch of time and tends to pick up more of them simply because it's watching for longer.
Three things get looked at: how often the beats happen, what they look like on the trace, and whether the heart is structurally normal. A handful of ectopic beats scattered through a whole day of monitoring is a completely different picture to beats that keep repeating in a run, or that make up a large share of the total heartbeats recorded. The shape of the beat on the ECG also tells a trained eye a lot, since some patterns are known to be entirely benign, like the common right ventricular outflow tract type, while others prompt a closer look. And an ectopic beat in a heart that's structurally normal on echo carries far less weight than the same finding in a heart with an underlying condition.
Most children with ectopic beats need nothing at all beyond that initial check. No medication, no restriction on sport or activity, and often no repeat testing unless something changes. A smaller number are asked to come back for a follow-up Holter after some months, mostly just to confirm the pattern is stable rather than because anything worrying was found the first time.
It's worth mentioning that caffeine, some cold and flu medicines, energy drinks, and periods of illness or dehydration can all make ectopic beats more noticeable for a while. If your teenager's palpitations seem to track with energy drinks or a bad cold, that's a genuine clue, not something to dismiss.
A proper assessment settles this quickly and definitively. Dr Giardini reviews the trace directly alongside a full history and, where needed, an echocardiogram, so a family leaves with a clear answer rather than a vague reassurance.
Very common. Isolated ectopic beats turn up in a large proportion of children who are monitored for any length of time, and in a structurally normal heart they're considered a normal variant rather than a disease.
In the large majority of cases, no. Activity restriction is only considered if the beats are frequent, form concerning patterns, or occur alongside an underlying heart condition, and that's decided on a case by case basis.
Many do lessen or disappear over time, particularly in younger children, though some persist without ever causing a problem. In a minority of children ectopic heart beats may indicate an underlying heart problem and these children will need to be followed up. Persistence alone isn't a reason for concern if everything else checks out.
It's a reasonable and easy thing to try, since caffeine and energy drinks can increase how often ectopic beats are felt or recorded, even though they don't cause the underlying tendency.
Usually when the beats are very frequent, form repeating runs, have a concerning shape on the ECG, or occur in a child with a known heart condition or family history of heart rhythm problems. Dr Giardini can advise after reviewing the trace whether that applies to your child.
Author: Dr. Alessandro Giardini, MD, PhD, Consultant Paediatric Cardiologist
Written 18/08/2026
Last reviewed 18/08/2026