Methylphenidate modestly increases heart rate and blood pressure; therefore, an electrocardiogram and consultation with a pediatric cardiologist are required prior to use in children with congenital heart defects, arrhythmias, or hypertension. The current medical consensus is that there is no clinically significant cardiovascular risk for otherwise healthy children. However, if palpitations, chest pain, or syncope occur during use, medication should be stopped immediately and a physician consulted.