Hi Cheryl,
Ah ejection fraction is the percentage of blood pumped with each heartbeat. For a perspective normal is an EF of 50 to 70%. Some insurance policies consider an EF below 29 % to be in heart failure range and often the EF is not enough oxygenated blood pumped to meet the system and heart's need to function without symptoms such as chest pains (angina). shortness of breath, fatique, etc. Some individuals function well with an EF below 29% because the totality of the system functionality has compensated, but uncorrected and successfully treated there will be over compensation and further weakening of the heart's ability to pump..
The heart related cause for low EF is the heart's walls have been damaged from an insufficient supply of oxygenated blood to the heart cells. The heart walls begin to lose their contractility and thus low EF and less oxygentated blood to the heart and that further lowers the EF.
Your son my have some heart muscle damage due to a virus, bacteria, a structual anomaly, low oxygen level in the blood, or there can be a vascular condition that limits the supply channeled to the heart, etc.
Often the EF can be increased if the underlying cause is successfully treated. Thanks for the question and if you have any other questions you are welcome to respond. Take care I wish your son well going forward. Take care