The aim is to summarize information about coronary artery fistulas (CAFs) in children, to establish the presence and dependence of clinical manifestations in children with CAFs depending on their size, to develop an algorithm for monitoring the state of the cardiovascular system of children with CAFs. Materials and methods. 5 children aged 8–12 years (average age 10±0.9), who were engaged in various sports. All children underwent electrocardiography, echocardiography with color Doppler. Results. Indicators of the morphofunctional state of the heart, hemodynamics were within the age-related norm. The presence of typical complaints of shortness of breath and palpitations, pain behind the sternum during physical exertion; continuous murmur — by auscultation and pathological shunting greater than 2 mm requires consultation with a cardiac surgeon to decide on further tactics of patient management. If the fistula is less than 2 mm and there are no typical complaints and physical signs, the management tactic is observation, echocardiography — once a year. Conclusions. Asymptomatic CAFs of small sizes can be classified as «small structural anomalies of the heart». CAFs may be asymptomatic and not detected during routine instrumental examination, but at the same time they remain a «silent» threat to the patient’s life. During echocardiographic screenings, it is imperative to pay attention to the anatomy of the coronary arteries. To prevent complications of CAFs, it is necessary to be monitored by a cardiologist and, at the first typical complaints for them, by a cardiac surgeon. Children with CAFs greater than 2 mm are recommended to limit physical activity (physical education group — preparatory) and exclude classes in sports sections.