Management of children at increased risk of infective endocarditis

Management of children at increased risk of infective endocarditis

The clinical management of children with high risk or moderate risk cardiac conditions is unlikely to be significantly different from that of comparable adult patients. However, be aware that extra consideration is required with regards to consent. Some children will have the capacity to provide valid consent for treatment (Gillick competence³⁴ or as defined by the Age of Legal Capacity (Scotland) Act 1991³⁵), while for other child patients the parent or carer will provide consent on the child’s behalf. See Shared decision making for more information on obtaining valid consent.

Children with high risk or moderate risk cardiac conditions are likely to have undergone multiple medical procedures, which may impact on their ability to accept dental treatment. As with any patient who is unable to cooperate (due to young age, a learning disability or where behaviour management techniques or referral for further behavioural support have been unsuccessful), referral to assess suitability for dental treatment under sedation or general anaesthesia should be considered.³⁶

Note that children with complex cardiac conditions are likely to have much of their dental care provided in secondary care or in the community/public dental service. If there are concerns regarding appropriate management of these children outwith these services, advice should be sought from a specialist paediatric dentist.