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Should You Be Concerned if Your Child Has Chest Pain?

David Epstein, MD, discusses the symptom of chest pain in children and the potential causes of the chest pain.

One often thinks of chest pain as an adult problem.

Images from medical television dramas often show an adult grasping their chest in pain and surprise as they experience a heart attack. However, not all chest pain presents like that. Also, not all chest pain occurs in adults. Kids can experience chest pain as well.
For children, there can be heart-related reasons for chest pain. But, these are rare and there are a number of other more common causes of chest pain in children. There are lung issues, problems with the musculoskeletal system, irritation of the esophagus, and other sources of chest pain in kids. However, most commonly, no reason is found for chest pain in children.
Heart-related chest pain in children is exceedingly rare with one study showing the heart identified as a cause of chest pain in 1% of a population seen at a cardiology clinic for chest pain. When the heart is the cause of chest pain in kids, myocarditis and pericarditis are the most common causes (inflammation of the heart muscle or the area around the heart, respectively). Viruses are most commonly responsible for myocarditis and pericarditis in children. Nevertheless, signs that the heart is involved in the chest pain include fainting or palpitations associated with the chest pain (fainting occurring with activity), chest tightness associated with the chest pain, or a family history of cardiac disease or sudden death. Abnormalities on physical exam and an electrocardiogram will further support a cardiac diagnosis as the cause of the chest pain.

As opposed to the heart, the most likely causes of chest pain in children are found within the musculoskeletal system.

Costochondritis, an inflammation of the junction between the ribs and the sternum, will present with chest pain and the pain is reproducible while pressing on the affected areas. This can be triggered by chest musculature overuse and is treated with rest and nonsteroidal anti-inflammatory medications, such as ibuprofen. Another common cause of musculoskeletal-related chest pain is muscle strain which commonly occurs with trauma or overuse. The muscles of the chest are involved and there is commonly a history of athletic activities or coughing.
Other less common causes of chest pain in children stem from the lungs and gastrointestinal system, as well as psychogenic sources. More common causes of chest pain due to a lung issue include asthma or respiratory infections, specifically pneumonia. Familiar causes of chest pain originating in the gastrointestinal system include gastrointestinal reflux, esophagitis, and foreign body ingestions. Finally, when all organic etiologies are ruled out, psychogenic reasons for chest pain can be considered. Psychogenic sources of chest pain in children can include stress, anxiety, and depression.
Fortunately, chest pain in children is most often a benign and self-limit process. However, it is a common concern for parents and can constitute a good portion of emergency room, urgent care, and clinic visits. A true cardiac reason for the cause of chest pain in children is rare. The remaining musculoskeletal, pulmonary, gastrointestinal, and psychogenic causes are often treatable. With this knowledge, parents should feel somewhat reassured that their child’s chest pain is not something very dangerous. However, visiting a medical professional for reassurance or concern would never be discouraged because chest pain in children can be scary.
Do you have any experience with children with chest pain? If so, please share it with us!

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