Congenital heart disease (CHD) is a problem with the way the heart forms before birth and occurs in about 1% of newborns.
It has previously been shown that school-age children, adolescents, and young adults with CHD are more likely to exhibit autistic features. Now, a British research team has shown that preschoolers with CHD are also at risk of developing behavioral problems. they know the result Frontiers of pediatrics.
“Here we show that children with congenital heart disease have higher levels of poor attention and poor peer relationships during the preschool years compared to healthy children, but that greater cognitive stimulation within the home environment may reduce the risk of developing such difficulties,” said corresponding author Chiara Nosarti, professor of neurodevelopment and mental health at King’s College London.
Nosarti and colleagues focused on 56 children aged 4 to 6 years with CHD enrolled in the Congenital Heart Imaging Project, led by Professor Serena Counsel at King’s College London, between 2014 and 2020. These children had severe CHD, including transposition of the aorta. or severe CHD (including non-severe cardiac lesions that required catheterization or surgery before 1 year of age).
The researchers compared these children to a cohort of 215 healthy control children enrolled in the UK’s Developmental Human Connectome Project, an unrelated program.
Measuring problematic behavior
The authors invited all parents to complete five proven questionnaires to measure a child’s overall behavioral profile, including the Child Behavior Questionnaire, the Social Communication Questionnaire, and the Empathy Questionnaire. Higher scores on these questionnaires indicate more severe behavioral problems.
The researchers used a postcode-based index of multiple deprivation as a proxy for parental socio-economic status. Parents were then asked to complete the 28-item Cognitively Stimulating Parenting Scale to measure how much their child’s environment stimulated their child’s cognitive development. This assesses the extent of verbal interaction and educational activities at home, as well as the availability of educational materials such as child-sized tables and chairs, picture books, coloring books, and musical instruments.
Analyzes showed that after adjusting for the effects of gender, gestational age at birth, and neighborhood deprivation, children with CHD were more likely to have ADHD and peer relationship problems than healthy children.
near home
Importantly, the results also showed that a highly stimulating home can protect against the development of these behavioral problems.
“It remains unclear whether the cognitively stimulating environment influences children’s behavior or whether children’s behavior influences the degree of cognitive stimulation provided by caregivers,” the authors write.
This study did not address the mechanisms that may cause the observed differences. However, they note in their study that peer relationship problems may be caused by children with CHD’s poor ability to recognize facial emotional expressions and identify false beliefs, which has been previously shown in school-age children.
Clinically, these findings suggest that the behavior of preschool children with CHD should be regularly assessed so that problems can be identified and children can be supported as early as possible. ”
Chiara Nosarti, Professor of Neurodevelopment and Mental Health, King’s College London
“Alongside cardiac care, environmental factors, such as fostering a stimulating home learning environment, should also be taken into account when planning support for children with CHD,” Professor Nosarti concluded.
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Reference magazines:
Chewing, ATM, others. (2026). Behavioral outcomes in preschool children with congenital heart disease and controls. Frontiers of pediatrics. DOI: 10.3389/fped.2026.1725994. https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2026.1725994/full.
