Medical Conditions

My Baby Has a Hole in Their Heart (Atrial Septal Defect)

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AHA, Mayo Clinic, NIH guidelines

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Last reviewed:

If your baby has been diagnosed with or you suspect has a hole in their heart (atrial septal defect), here is what the evidence says.

The short answer

An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates.

Key takeaways

  • An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates.
  • Usually normal when: Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate
  • Call your doctor if: Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
  • Varies by age — see the age-by-age breakdown below
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What Parents Should Know

According to AHA, Mayo Clinic, NIH guidelines, an atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates. At 0-6 months, small ASDs are often discovered incidentally during evaluation of a heart murmur or during echocardiography performed for other reasons. Many small ASDs — particularly those under 5mm — close spontaneously in the first 1-2 years. Your pediatric cardiologist will monitor with periodic echocardiograms. Most babies with small ASDs have no symptoms and feed, grow, and develop normally. It is generally considered normal when your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate. However, you should contact your pediatrician promptly if your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate
Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
Your baby has a PFO (patent foramen ovale) — this is present in 25% of all people and rarely needs treatment
Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation
Your child had ASD closure and has recovered with normal heart function
After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care

When to Seek Immediate Care

  • Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
  • Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation
  • After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care

By Age

What to expect by age

0-6 months

Small ASDs are often discovered incidentally during evaluation of a heart murmur or during echocardiography performed for other reasons. Many small ASDs — particularly those under 5mm — close spontaneously in the first 1-2 years. Your pediatric cardiologist will monitor with periodic echocardiograms. Most babies with small ASDs have no symptoms and feed, grow, and develop normally.

6-12 months

If the ASD is small and your baby is asymptomatic, watchful waiting continues. Moderate to large ASDs may cause subtle symptoms — slightly faster breathing, difficulty with feeds, or slower weight gain — though many moderate ASDs are still asymptomatic in infancy. Your cardiologist will assess the amount of blood flow across the defect to determine if and when closure is needed.

1-5 years

Small ASDs that have not closed may continue to be monitored. Moderate to large ASDs with significant left-to-right blood flow are typically recommended for closure during this period, before they cause right heart enlargement. Catheter-based device closure (Amplatzer or similar device) is the preferred method for secundum ASDs and is performed in a cardiac catheterization lab without open-heart surgery. Recovery is quick — most children go home the next day.

5 years+

If closure is performed, long-term outcomes are excellent — the heart returns to normal size, and there are typically no activity restrictions after recovery. Children who had device closure take aspirin for about 6 months and need endocarditis prophylaxis for 6 months after the procedure. If surgical closure was required (for large or non-secundum ASDs), recovery takes several weeks but outcomes are equally excellent.

What to Tell Your Pediatrician

  • Describe when you first noticed has a hole in their heart (atrial septal defect) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby seems to tire easily during feeds or sweats during feeding.
  • Mention if your baby is not gaining weight as expected.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate
  • Your baby has a PFO (patent foramen ovale) — this is present in 25% of all people and rarely needs treatment
  • Your child had ASD closure and has recovered with normal heart function
Mention at your next visit when...
  • Your baby seems to tire easily during feeds or sweats during feeding
  • Your baby is not gaining weight as expected
  • You hear your baby breathing faster than usual, especially during feeding or activity
  • You have questions about whether and when the ASD should be closed
Act now when...
  • Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
  • Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation
  • After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care

What You Can Do at Home

  • Keep track of when you notice has a hole in their heart (atrial septal defect) — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate — this is generally within the range of normal.
  • At 0-6 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911.

My Baby Was Diagnosed with VACTERL Association

VACTERL association is a condition where a baby is born with a combination of birth defects involving multiple organ systems. The name is an acronym: Vertebral defects, Anal atresia, Cardiac defects, Tracheoesophageal fistula, Renal anomalies, and Limb abnormalities. A diagnosis is typically made when a baby has at least 3 of these features. The cause is unknown in most cases and is usually not inherited. While the initial medical needs can be significant, many VACTERL-associated conditions are surgically correctable, and many children go on to lead healthy, active lives.

My Baby Was Diagnosed with 22q11.2 Deletion Syndrome (DiGeorge)

22q11.2 deletion syndrome (also known as DiGeorge syndrome or velocardiofacial syndrome) is caused by a small missing piece of chromosome 22 and is the most common microdeletion syndrome, affecting about 1 in 4,000 births. It can affect many body systems — heart, immune system, palate, calcium regulation, learning, and behavior. The severity varies widely, even within the same family. Some children have significant medical needs, while others have mild features. With appropriate monitoring and support, many people with 22q11.2 deletion syndrome lead fulfilling, independent lives.

My Baby Was Diagnosed with Noonan Syndrome

Noonan syndrome is a genetic condition occurring in about 1 in 1,000-2,500 births, caused by mutations in genes of the RAS-MAPK pathway. It affects multiple body systems and is characterized by distinctive facial features, short stature, heart defects (most commonly pulmonary valve stenosis), and varying degrees of developmental delay. While Noonan syndrome is a lifelong condition, the wide range of severity means that many people with Noonan syndrome lead independent, fulfilling lives. Early intervention and comprehensive medical care significantly improve outcomes.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is has a hole in their heart (atrial septal defect) normal?
An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates.
When should I call the doctor about has a hole in their heart (atrial septal defect)?
Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911 Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care
When is has a hole in their heart (atrial septal defect) normal?
Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate Your baby has a PFO (patent foramen ovale) — this is present in 25% of all people and rarely needs treatment Your child had ASD closure and has recovered with normal heart function
What causes has a hole in their heart (atrial septal defect)?
An atrial septal defect (ASD) is a hole in the wall (septum) between the two upper chambers of the heart. Small ASDs are very common — a patent foramen ovale (PFO), which is essentially a small ASD, is present in about 25% of all people. Many small ASDs close on their own during childhood. Moderate to large ASDs may need closure to prevent long-term complications like heart enlargement or pulmonary hypertension. Closure is done either through a catheter-based procedure (device closure) or surgery, both with excellent success rates. Common explanations include: Your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate. Your baby has a PFO (patent foramen ovale) — this is present in 25% of all people and rarely needs treatment.
What should I mention to my pediatrician about has a hole in their heart (atrial septal defect)?
You should mention has a hole in their heart (atrial septal defect) at your next visit if: Your baby seems to tire easily during feeds or sweats during feeding. Your baby is not gaining weight as expected. You hear your baby breathing faster than usual, especially during feeding or activity.
Is has a hole in their heart (atrial septal defect) normal at 0-6 months?
Small ASDs are often discovered incidentally during evaluation of a heart murmur or during echocardiography performed for other reasons. Many small ASDs — particularly those under 5mm — close spontaneously in the first 1-2 years. Your pediatric cardiologist will monitor with periodic echocardiograms. Most babies with small ASDs have no symptoms and feed, grow, and develop normally.
Is has a hole in their heart (atrial septal defect) normal at 6-12 months?
If the ASD is small and your baby is asymptomatic, watchful waiting continues. Moderate to large ASDs may cause subtle symptoms — slightly faster breathing, difficulty with feeds, or slower weight gain — though many moderate ASDs are still asymptomatic in infancy. Your cardiologist will assess the amount of blood flow across the defect to determine if and when closure is needed.
Should I go to the ER for has a hole in their heart (atrial septal defect)?
Seek emergency care if your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911, or if your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation. When in doubt, call your pediatrician's after-hours line for guidance.
Does has a hole in their heart (atrial septal defect) go away on its own?
In many cases, has a hole in their heart (atrial septal defect) resolves on its own, especially when your baby has a small ASD that your cardiologist says is likely to close on its own — monitoring with periodic echocardiograms is appropriate. By 5 years+, if closure is performed, long-term outcomes are excellent — the heart returns to normal size, and there are typically no activity restrictions after recovery. Children who had device closure take aspirin for about 6 months and need endocarditis prophylaxis for 6 months after the procedure. If surgical closure was required (for large or non-secundum ASDs), recovery takes several weeks but outcomes are equally excellent.
AHAMAYO CLINICNIH

References

  1. [1]American Heart Association. Atrial Septal Defect (ASD). AHA
  2. [2]Mayo Clinic. Atrial Septal Defect (ASD). Mayo Clinic
  3. [3]National Heart, Lung, and Blood Institute. Atrial Septal Defect. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss My Baby Has a Hole in Their Heart (Atrial Septal Defect).

Things to mention

  • Describe when you first noticed has a hole in their heart (atrial septal defect) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your baby seems to tire easily during feeds or sweats during feeding.
  • Mention if your baby is not gaining weight as expected.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your baby seems to tire easily during feeds or sweats during feeding
  • Your baby is not gaining weight as expected
  • You hear your baby breathing faster than usual, especially during feeding or activity

Urgent signs to report immediately

  • Your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911
  • Your baby has a sudden onset of rapid breathing, excessive sweating, and poor feeding — these may be signs of heart failure and need urgent evaluation
  • After device or surgical closure, your child develops fever, chest pain, or sudden shortness of breath — seek immediate medical care

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

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Bottom line

Most cases of has a hole in their heart (atrial septal defect) are normal. Talk to your pediatrician if your baby is having difficulty breathing, turning blue or grey, or is very lethargic — call 911.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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My Baby Was Diagnosed with VACTERL Association

VACTERL association is a condition where a baby is born with a combination of birth defects involving multiple organ systems. The name is an acronym: Vertebral defects, Anal atresia, Cardiac defects, Tracheoesophageal fistula, Renal anomalies, and Limb abnormalities. A diagnosis is typically made when a baby has at least 3 of these features. The cause is unknown in most cases and is usually not inherited. While the initial medical needs can be significant, many VACTERL-associated conditions are surgically correctable, and many children go on to lead healthy, active lives.

My Baby Was Diagnosed with 22q11.2 Deletion Syndrome (DiGeorge)

22q11.2 deletion syndrome (also known as DiGeorge syndrome or velocardiofacial syndrome) is caused by a small missing piece of chromosome 22 and is the most common microdeletion syndrome, affecting about 1 in 4,000 births. It can affect many body systems — heart, immune system, palate, calcium regulation, learning, and behavior. The severity varies widely, even within the same family. Some children have significant medical needs, while others have mild features. With appropriate monitoring and support, many people with 22q11.2 deletion syndrome lead fulfilling, independent lives.

My Baby Was Diagnosed with Noonan Syndrome

Noonan syndrome is a genetic condition occurring in about 1 in 1,000-2,500 births, caused by mutations in genes of the RAS-MAPK pathway. It affects multiple body systems and is characterized by distinctive facial features, short stature, heart defects (most commonly pulmonary valve stenosis), and varying degrees of developmental delay. While Noonan syndrome is a lifelong condition, the wide range of severity means that many people with Noonan syndrome lead independent, fulfilling lives. Early intervention and comprehensive medical care significantly improve outcomes.

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