Chest Pain in Kids:  A Common Complaint

Chest pain in kids is a very common complaint that is often heard from young children to teenagers. More often than not it is not a symptom of heart disease in children. In fact, over 95% of children referred to see a pediatric cardiologist for chest pain, do not have any identifiable heart cause.

Parents will appropriately ask what is the cause of chest pain. As there are multiple structures in the chest, there are many different causes of chest pain. I try to think about different causes of chest pain as follows.

Chest Pain in Kids:  Musculoskeletal Causes

Probably the most common forms of chest pain in kids are related to some irritation in the chest wall or the musculoskeletal system. People will use the term growing pains and I think this usually represents costochondritis or inflammation of the joints between the ribs and the breastbone. This usually hurts to push on the chest. As this is an inflammation, using anti-inflammatory medications such as Motrin or Aleve can help. Another common cause is what we term as precordial catch syndrome. I have had this pain and describe it as a sudden and severe pain in the left chest. It will sometimes hurt when I breathe and I’ll try to move to allow the pain to “release”. As quickly as it comes on it will often disappear quickly in a matter of minutes. We are unaware what causes this type of pain, but it is very common and does not seem to be associated with any more severe illness. Sometimes children will also strain or injure the chest wall during sports or workouts. Like other types of soreness, allowing time and over the counter pain medications will allow these symptoms to resolve.

Chest Pain in Kids:  Lung Causes

There are many lung causes of chest pain. Asthma can lead to chest tightness and difficulty catching ones breath. This is a very important cause of chest pain in kids that can be treated and improves ones quality of life. More significant pulmonary causes of chest pain in kids can occur too. Fever and chest pain could represent a lung infection. Severe and persistent chest pain can be a symptom of pneumothorax or air around the lungs. Obviously, severe and persistent chest pain, especially associated with a fever should be evaluated by a physician.

Chest Pain in Kids:  Stomach Causes

Some children will experience chest pain at night while lying down for bed or even wake up at night. As adults, we will feel heart burn after certain meals, children can also experience these symptoms. These symptoms can be treated with antacid medications. And just like stress and anxiety can make people feel uncomfortable symptoms, sometimes children can feel this into their chest.

Chest Pain in Kids:  Cardiac Causes

As I state above, over 95% of chest pain referrals to a pediatric cardiologist are non-cardiac and with that, most are not life threatening. However, there are important cardiac causes of chest pain in children. As with pulmonary causes of chest pain, persistent and severe chest pain, associated with fever can represent pericarditis or an inflammation in the sack the surrounds the heart. Chest pain that occurs repetitively with exercise and symptoms of passing out with exercise can be very important. There are rare coronary artery origin anomalies that can cause these types of symptoms. Other causes can be severe valve abnormalities or hypertrophic cardiomyopathy. In general, many of the cardiac causes of chest pain can be sorted out with good historical evaluations and physical examination and simple tests such as an electrocardiogram and echocardiogram.