This article is for the teacher and the parent
A child with a heart defect starts school. The parent is anxious: how do I explain this to the teacher? The teacher is anxious: what's allowed, what's not, what do I do if something happens? The child ends up caught between two sets of anxiety — and nobody has a clear set of instructions.
This article closes that gap. Not a medical textbook — a practical guide for the people who are with the child every day. Print it and hand it to the class teacher. Forward it to a school counsellor. Read it yourself as a parent before the meeting with the teacher.
First, the most important point: most children with heart defects are ordinary children
A heart defect is not a sentence, and it is not a state of permanent fragility. The majority of children who have been treated or are under follow-up attend a regular school, socialise with classmates, and participate in school life. They do not need to be kept under a glass dome.
The challenge is different: every child has their own diagnosis, their own surgical history, their own specific restrictions. There are no universal rules "for all children with heart defects." This is precisely why direct communication between the parent, the doctor, and the teacher at the start of each school year is so important.
What follows are general guidelines. Specific restrictions for a specific child should always be confirmed with the cardiologist or cardiac surgeon who follows them.
Physical education: what's allowed, what isn't, how to know
Physical education is the most frequent source of conflict and anxiety. The teacher doesn't know whether to let the child run a hundred metres. The parent is afraid of any physical exertion. The child wants to be like everyone else.
The general principle is this: moderate physical activity is not only permitted for most children with heart defects — it is beneficial. Blanket exemption from PE is not a medical standard; it is a common over-precaution that ultimately harms the child both physically and psychologically.
What is genuinely restricted is intensive competitive exercise, working at maximum heart rate, strength exercises with breath-holding (pressing, straining pull-ups), and sustained high-speed running. But even these restrictions are individual. A child after a small ASD repair may have none at all. Another child after complex reconstruction may have specific, defined ones.
In practice this works as follows: at the start of the school year, the parent brings a letter from the cardiologist specifying the PE group (full participation, preparatory, or restricted) and any concrete load restrictions. The PE teacher works from this letter. If there is no letter — getting one is the parent's responsibility.
Important: if the child says "I feel unwell" during exercise — this is not pretending. It is a signal to stop. Always.
Signs to watch for in the classroom
Teachers don't need to be doctors. But they do need to know a few signals that require an immediate response — calling a school nurse, phoning parents, or if necessary, calling an ambulance.
Sudden pallor or bluish colour of the lips and fingertips. If the child has noticeably gone pale or blue — this is not normal. Immediately calm the child, sit or lay them down, and call the school nurse.
Complaints of a pounding or racing heart. Especially if this occurs suddenly at rest or after minimal activity — stop the activity and observe. If it does not settle within 5–10 minutes — call an ambulance.
Dizziness, weakness, or near-fainting. The child says "everything is spinning," "my vision is going dark," "my legs won't hold me." Immediately sit or lay them down (legs slightly elevated above the head), do not allow them to stand, call the school nurse.
Breathlessness without obvious cause. If the child is breathing heavily at rest or after minimal activity — this is a warning sign.
Pain or pressure in the chest. Any complaint of chest pain in a child with a heart defect is grounds for calling an ambulance immediately and phoning the parents. Do not wait and observe.
If the child loses consciousness: step-by-step actions
2. Lay the child on their back, raise their legs 20–30 cm (use a bag or a chair).
3. Check breathing — can you see the chest rising, can you hear breathing.
4. If breathing — call an ambulance and phone the parents. Stay with the child.
5. If not breathing — begin CPR immediately and call an ambulance.
6. Do not use smelling salts, do not slap the cheeks, do not give water while unconscious.
7. Do not lift or sit the child up before medical help arrives.
Most fainting episodes in children with heart defects are vasovagal (caused by sudden standing, heat, or stress) and resolve on their own within 1–2 minutes. But a teacher cannot know this in advance, so the rule is simple: an ambulance and the parents are always called.
Does the child need a special school routine?
For most children — no. Normal timetable, normal lessons, normal breaks. Restrictions relate to physical load and are specified in the cardiologist's letter.
There are a few things worth the school noting without overdramatising.
Heat and stuffy rooms. Children with heart defects tolerate overheating less well. In hot weather — access to water and the ability to step out of a stuffy room. This is not a privilege; it is basic health.
Medications. If the child takes medications on a schedule during school hours, the school needs to know. Ideally the school nurse keeps the medication and dispenses it at the right time. If there is no nurse — agree with the relevant staff member on who manages this and how.
Stress and emotional load. Strong stress can trigger arrhythmia in some children. This does not mean "shield them from every conflict" — but it means the teacher should know: if the child complains of a racing heart after strong anxiety, this is a normal reaction worth observing.
Psychological comfort. A child with a heart defect sometimes carries the parent's anxiety to school. They may fear physical activity, fear "being different." A teacher who treats them calmly without emphasising the condition does more for the child than any medical instruction.
What parents should tell the school at the start of the year
There is no need to hand the teacher a full medical file. The goal is to share specific, practically useful information.
The diagnosis — briefly and clearly. "My child has an operated heart defect" or "congenital heart defect under cardiology follow-up" is enough. Anatomical details are not something the teacher needs.
A letter from the cardiologist stating the PE group and any specific load restrictions. This is a mandatory document.
A list of medications (if taken during school hours) with dosage and timing.
What to do if the child feels unwell — a concrete plan agreed with the cardiologist. Better written on a single sheet and given to both the teacher and the school nurse.
Contact numbers — the parent's phone, the cardiologist's or clinic's phone. One call at the right moment resolves everything.
And finally: update this information every year. After each planned cardiology visit, check whether the restrictions have changed — and let the school know.
What a teacher should not do
This matters — because well-intentioned teachers can sometimes cause real harm.
Don't exempt the child from everything "just to be safe." Physical inactivity is harmful for the heart. If the child has been cleared for a preparatory PE group — they should take part in that group, not sit on the bench for the entire lesson.
Don't discuss the diagnosis with the class without the parent's knowledge. This is the child's medical information. If classmates ask — "they have some health limitations" is enough. The details are not your decision to share.
Don't panic at every complaint. A child with a heart defect who feels tired after running — that's normal. A child who loses consciousness — that's an ambulance. The difference exists and it matters.
Don't treat the child as "ill." Pity, constant monitoring, public reminders about the condition — this is psychological harm, not care. The child wants to be an equal among equals.
In brief — for those forwarding this to a teacher
A child with a heart defect is not a fragile object. They study, make friends, sometimes misbehave, sometimes get tired. They need not a special regime, but an understanding adult nearby.
Three things a teacher needs to know: which physical activities are allowed (from the cardiologist's letter), what warning signs look like, and what to do if the child faints. Everything else — same as with any other child.
If there are questions — the parent can always reach our clinic. We advise not only patients, but those who are alongside them.