Chest pain in children is extremely common. In fact, it is one of the most frequent reasons why a child may be referred to a cardiologist. It affects girls and boys equally.
Numerous studies have shown that chest pain can have a significant impact in the lives of children. Over half of children with chest pain will miss some school due to it. Restriction of activity, both by the child as well as by parents and other adults, is common. Chest pain in children can be a source of significant anxiety, both for the child as well as others. Chest pain may be perceived differently in young children compared to teenagers. For instance, a very young child may complain that “my chest hurts” when in fact, he or she may be sensing an abnormal heart rhythm rather than true pain.
Fortunately, chest pain in children is rarely due to a heart condition, unlike in adults. More than 95 percent of children who have chest pain will not have anything wrong with their heart. Unfortunately, chest pain in children can be frustrating because it is very commonly recurrent, and often a specific reason may not be able to be diagnosed and therefore specifically treated.
A detailed patient history with complete review of all of the major body systems by your healthcare provider is the most useful part of the evaluation of chest pain in children. Your pediatrician or pediatric cardiologist will ask questions such as the following:
- Where is the pain located?
- How long has the pain been present?
- How often does the pain last?
- How long does the pain last before going away?
- Does the pain occur at rest or with exercise?
- Is the pain associated with an irregular or fast heart rhythm?
- Have you had any recent illnesses or fevers?
- Have you had any episodes of passing out (syncope)?
- Have you had any injuries to your chest recently?
Common causes of chest pain in children include:
- Musculoskeletal – irritated chest muscles, cartilage or ribs
- Lungs – irritation of a lung’s membrane (pleuritic irritation) or asthma-related symptoms
- Gastrointestinal – acid reflux, esophageal spasms, difficulty swallowing
- Psychogenic – chest pain can be commonly associated with anxiety
- Idiopathic – no specific cause can be found; this is the most common occurrence
In children, there are no tests that are consistently useful in diagnosing the cause of chest pain.
- A chest x-ray exposes the child to radiation and rarely makes a specific diagnosis.
- An electrocardiogram may be useful if an abnormal heart rhythm is suspected.
- An echocardiogram is generally not helpful unless specific cardiac disorders are suspected.
In rare cases, cardiac causes of chest pain in children may include:
- Abnormal coronary artery anatomy – branches arising and traveling abnormally
- Pericarditis – inflammation of the sac surrounding the heart
- Myocarditis – inflammation of the heart muscle itself
- Kawasaki disease – aneurysms of the coronary arteries
- Hypertrophic cardiomyopathy – abnormal thickening of the heart
- Abnormal heart rhythms
- Connective tissue disorders, such as Marfan syndrome
Fortunately, the vast majority of children with chest pain will eventually have complete resolution of their symptoms. Most children with chest pain will not need to be restricted from sports or other activities. A detailed history and physical examination are very important in understanding why a child has chest pain and if the discomfort should not be of great concern. If a cardiac reason is suspected, your doctor will refer you to a pediatric cardiologist for further evaluation.