Early Emotional, Behavioural and Social Development of Infants and Young Children with Congenital Heart Disease: A Systematic Review

  • Tamera ClancyEmail author
  • Brigid Jordan
  • Carolina de Weerth
  • Frank Muscara


The experiences of diagnosis of congenital heart disease (CHD), cardiac surgery and hospitalisation(s) are distressing and represent a significant stressor for a child and family, which may impact psychosocial development. This systematic review provides a synthesis of psychosocial outcomes of infants and young children with congenital heart disease who had cardiac surgery early in life. Twenty-eight studies related to infant and young children’s psychosocial development, specifically emotional, social and behavioural functioning were identified. Variability was related to methodological factors including differences in study design, varying measurement tools and heterogeneous samples. Despite these limitations, the majority of studies were of high quality. The most common finding was a high prevalence of low-severity emotional and behavioural dysregulation. Young children with severe CHD or comorbid conditions experienced greater impairment, with higher rates of externalising behaviour problems, although internalising behaviour problems were also evident. This review integrates findings from literature in the past 28 years on the psychosocial well-being of infants and young children with CHD and demonstrates a risk for emotional, social and behavioural development difficulty, and, importantly, that symptoms of psychosocial impairment are detectable very early in infancy. We advocate for assessment and monitoring of emotional and behavioural regulation and social development to be routinely conducted from infancy to enable prevention and early intervention.


Psychosocial Development Infants/young children Congenital heart disease 



The research project reported in this published work was conducted by the authors as part of their Doctorate in Pediatrics at the University of Melbourne, or employment with the Murdoch Children’s Research Institute, or The Royal Children’s Hospital, Melbourne, Australia. No funding support was received for this project. The authors have full control of all primary data and agree to allow the journal of publication to review the data if requested.

Compliance with Ethical Standards

Conflict of interest

Tamera Clancy, Frank Muscara, Carolina de Weerth and Brigid Jordan all declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

No animal or human studies were carried out by the authors for this article.


References marked with an asterisk * indicate studies included in the review

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Authors and Affiliations

  1. 1.Department of PediatricsUniversity of MelbourneMelbourneAustralia
  2. 2.Brain and MindMurdoch Children’s Research InstituteMelbourneAustralia
  3. 3.The Royal Children’s HospitalMelbourneAustralia
  4. 4.Donders Institute for Brain, Cognition and BehaviourRadboud University Medical CenterNijmegenThe Netherlands

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