Nighttime PVC's

I am concerned about my 5 year old grandson.   He is very healthy, but has PVC's (I have listened with a stethoscope and am an RN) at night, when sleeping.   Basically no other symptoms.  He saw his pediatrician, who put him through the paces (run, jump, etc.) and she never found anything wrong.   He hasn't had a Holter monitor, or anything.   One time, when playing soccer, he was kind of holding his chest, but no other symptoms.  Could have been muscular.
Can this be a normal thing in children?   He is normal weight, 8 pounds at birth, full-term.
The pediatrician says only to worry if he has symptoms.

[Jeffrey R Boris, M.D.]

Dear DJ,

At this point, it is hard to say without him having any specific documentation of his rhythm, exactly what his rhythm abnormality is.  It also could certainly be respiratory variation, in which the heart rate speeds up with inspiration and slows down with expiration.  So, the first thing that I would recommend is actually documenting what the rhythm is.  If he does have early beats (premature atrial or ventricular contractions), it would make sense for him to be evaluated by a pediatric cardiologist.  That evaluation would likely include a 24 hour Holter monitor as well as an echocardiogram; in an older child, it might also include an exercise stress test.  These tests show how frequently the early beats are happening, if there are any structural reasons for the early beats (like tumors, etc.), and if it worsens with exercise, respectively.  Of note, if it does suppress with activity, we consider this to be benign, so that would be a good thing.