My 13-year old daughter wants to get her ears pierced.  She has a form
of the congenital heart disease (CHD) Ebstein's Anomaly, a heart
defect in which the tricuspid valve is abnormally formed. (See
http://www.americanheart.org/presenter.jhtml?identifier=11075 ) 

The severity of this condition can vary widely. She is on the very
mild end of the spectrum. She is growing and maturing normally, has
never had any significant symptoms, is fully active physically, and is
checked yearly by a pediatric cardiologist, with good results.

However, as most CHD patients do, she must take antibiotics before
dental work, to mitigate against bacterial endocarditis. (See
http://www.americanheart.org/presenter.jhtml?identifier=4436 )

I know the ultimate answer must come from her personal physician. 
That will answer whether the piercing itself would be a significant
risk, if antibiotics are administered. But I'm having trouble figuring
out the following:

1) With pierced ears, is there a risk of "follow-up" bleeding; i.e.
can they routinely bleed and get infected after the initial piercing
has healed?
2) Does piercing in a doctors office significantly reduce the risk of infection?

Thanks

1-Piercing procedure is considered as infectious as a dental
procedure. Anytime there is bleeding and contact of the venous and
lymphatic system with the outside world, there is a risk of infection.
Your daughter will need to take a dose of antibiotics before and after
the procedure as done in dental procedures. Follow up bleeding does
not typically occur after piercing is done and the skin is healed,
unless there is accompanying "clotting disorder". There is no routine
infections either. The problems are more related to allergic reactions
and contact dermatitis relateed to nickel containing accessories.

2- Absolutely, yes. Piercing in Dr.'s office significantly reduces the
risk of infections. This is related to "standarts of procedures" since
physicians are very familiar and in tune with infectious processes
relating to procedures, and are very well trained to perform them
under "sterile or disinfected" conditions. I would suggest that you
reveal your concerns to the Dr who will perform the procedure and ask
that he/she follows the highest possible sterile practice. The tools
that are used to pierce the ear lobes should also be well sterilized.

Please confirm all the above with the Pediatric Cardiologist and let
him be the final decision maker on thsi subject.

Good luck.