Holter Monitoring is a way to continuously check the electrical activity of the heart .

Continuous ECG recording show to be one of the most effective noninvasive clinical tools in the diagnosis of cardiac symptoms prognostic assessment and in the evaluation of many cardiac therapeutic intervention.

The clinical utility of ambulatory ECG lies in its ability to examine continuously a patient over an extended period of time, permitting patient ambulatory activity and facilitating the diurnal electrocardiographic examination of a patient in a changing environmental conditions (both physical and psychological) .

Inclusion Criteria:

• 1- children admitted to pediatric department as in :
• Pediatric intensive care unit (PICU).
• Pediatric critical care unit (PCCU).
• Emergency room (ER). 2- Age from 1 month- 12 years. 3- Critical ill child fulfill these criteria:
• Persistent convulsions.
• Abnormal GCS
• Haemodynamic instability
• Foreign body inhalation
• Sever cardiac problem
• Irregular breathing
• DKA
• Others

Exclusion Criteria:1-Neonates 2-End-stage or those with end-organ failure . 3-Whom GCS is below 6. 4-Whom done cardiac catheterization for any purpose . 5-Previously done Holter. 6-Multiple traumatized patient.

Critically ill children are those children whom requiring, or potentially requiring, high reliance or serious consideration.

There are variant emergent conditions may affect the child, such as airway problems which includes tonsillitis, airway obstruction which caused be foreign-body, pneumonia, asthma, and bronchitis, in addition to cardiac arrest and respiratory failure. There is also abdominal pain diarrhea, nausea, and vomiting. Child also may face seizures, poisoning sudden infant death syndrome (SIDS).

• Having seizures; unusual movements.
• No spontaneous development, unfit to sit or stand.
• Less alert or drew in with clinician or parental figure; not resisting of the examination.
• No interaction or eye-to-eye connection with individuals and the surrounding.