Cardiac Neurodevelopmental Services

As advances in medicine help more children with complex congenital heart conditions survive, some children treated for these conditions are at a higher risk for delays in early development and problems with thinking, learning or behaviors in childhood and teenage years.

Cardiac neurodevelopmental services at CHOC provides assessment of your child’s developmental, cognitive, and behavioral strengths and weaknesses from infancy until adulthood. Our goal is to identify children who are at risk for having problems with thinking, learning or behaviors and make sure they get the support services they need. Early assessment and services help prevent problems in the future.

Smiling blond boy

When a Neurodevelopmental Assessment Is Needed

Even children who are on track when they are young can show delays when they start school, or when they go through transition points, such as 3rd grade or starting middle school, where expectations are increased. The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend developmental or neuropsychological testing for all children who have high-risk congenital heart disease. CHOC is the only hospital in Southern California that is a member of the Cardiac Neurodevelopmental Outcome Collaborative, whose members are committed to optimizing outcomes for individuals with pediatric and congenital heart disease through clinical, quality improvement and research initiatives. Evaluation is recommended for children with:
  • Open heart surgery as a newborn/infant
  • A heart condition that causes decreased oxygen levels (cyanotic heart lesions)
Or, more than one of the following:
  • Prematurity
  • Developmental delay
  • Genetic syndrome associated with developmental delays
  • History of mechanical support (ECMO or VAD use)
  • Heart transplant
  • Cardiopulmonary resuscitation (CPR)
  • A hospital stay longer than two weeks after cardiac surgery
  • Perioperative seizures related to congenital heart disease surgery
  • Abnormalities on neuroimaging
If your child does not qualify based on the high-risk criteria, but you are concerned about your child’s development, please discuss your concerns with your cardiologist. Concerns you may have noticed include: In early development
  • Delays in learning to crawl, walk or run
  • Problems with hands, such as picking up small toys or hold a crayon to scribble
  • Difficulties with eating enough to grow as expected
  • Says or understands fewer words than other kids their age
During childhood and teenage years
  • Learning at a slower rate than their peers
  • Slower to learn academic skills in math, reading and writing
  • Inattention
  • Impulsivity
  • Messy, disorganized or often loses things
  • Less able to follow multi-step directions than other children their age
  • Knows or understands fewer words than children the same age
  • Messy handwriting or less-developed drawing skills
  • Problems making or keeping friends

What Is a Cardiac Neurodevelopmental Assessment?

The American Heart Association and the American Academy of Pediatrics recommend developmental testing for all children who have high-risk congenital heart disease.

Your child’s evaluation will involve activities to help identify strengths and weaknesses related to thinking, behavior and social-emotional functioning, and is completed in one day for most children. Your child will be asked many questions and be asked to solve different types of problems, both handwritten and on a computer. The doctor may also speak with your child’s teachers and other medical providers as a part of the evaluation.

Young boy playing with wall games

Recommendations Tailored to Each Child

Therapy session with a pediatric psychologistOnce our neuropsychologists complete an evaluation, they meet with the child’s family to discuss the results, as well as provide a custom report that can be shared with the child’s pediatrician, referring physician and school. The report includes recommendations for treatment to help a child improve his or her overall cognitive function. We work closely with families to ensure that their child receives the recommended therapies.

Contact us

Cardiac Neurodevelopment Assessments are performed in either the CHOC High-Risk Infant Follow-Up Clinic or in the CHOC psychology offices. Please note that assessments require a referral by your child’s physician. To schedule an appointment, please call 888-770-2462.


High-Risk Infant Follow-Up Clinic
Building: CHOC Clinic
1201 W. La Veta Ave.
Orange, CA 92868

CHOC Psychology Office
Building: Centrum North
1120 W. La Veta Ave., Ste. 470
Orange, CA 92868