NADA's criteria are used for –
The assessment of a child for the absence or presence of Heart disease can be done with the help of some guidelines suggested by NADA and are called NADA's criteria.

NADA's Criteria

Either one major or two minor criteria are necessary for indicating the presence of heart disease.

A) Major Criteria
1) Systolic murmur of grade III or more.


The systolic murmur is classified into : -


Ejection systolic murmur
Pansystolic murmur


Pansystolic murmur is always abnormal no matter what is its intesity.
Only three lesions produce pansystolic murmur          

i) VSD                         
ii) MR                       
iii) TR

Ejection systolic murmur, on the other hand, may be organic or functional.  an If ejection systolic murmur is associated with thrill, it is always organic.
If ejection systolic murmur is more than grade III intensity → It is organic.
Grade III or less ejection systolic murmur of a functional type may be heard in anemia or high fever in otherwise normal children.

2) Diastolic murmur

Presence of diastolic murmur always indicates the presence of organic heart disease.
There are two exceptions.


Severe hypertension → Reduction of BP may cause an AR murmur to disappear.
Anemia → May result in delayed diastolic murmur across the tricuspid and mitral area.

3) Cyanosis

Central cyanosis indicates the presence of heart disease if lung disease has been excluded.

4) CHF

Presence of CHF indicates the presence of heart disease except in neonates and infants who get CHF from causes such as hypoglycemia and anemia.

B) Minor criteria

Systolic murmur less than grade III in intensity.
Abnormal second heart sound


Abnormal S2 always indicates the presence of heart disease.
It has been included as a minor criterion only because auscultation is an individual and subjective finding

3) Abnormal ECG

The main value of ECG lies in determining the : -


Mean QRS axis
Right or left atrial hypertrophy
Right or left ventricular hypertrophy

4) Abnormal X-ray

 If there is cardiomegaly in a good inspiratory film, it is highly suggestive for the presence of heart disease.

5) Abnormal BP
Assessment of child for degree of dehydration
Assessment of child for degree of malnutrition
Assessment of child for presence of heart disease
Assessment of child for degree of mental retardation