Chest Pain in Children

Overview

Chest pain (angina) in children is extremely common. In fact, it’s one of the most frequent reasons a child may be referred to a cardiologist. It affects males and females equally.

Chest pain in children can be a source of anxiety for the child and others. Chest pain may be perceived differently in young children compared to adolescents. For instance, a young child may complain that “my chest hurts” when, in fact, the child may be sensing an abnormal heart rhythm rather than true pain. However, it's important to note that chest pain in children (and adolescents) is most commonly not from an abnormal heart rhythm and is usually not as serious as it seems. Restriction of activity, both by the child, parents, and other adults, is common; however, children with chest pain often won’t need to be restricted from sports or other activities.

Fortunately, chest pain in most children (unlike adults) is rarely due to a heart condition. Unfortunately, chest pain in children can be frustrating because it often recurs, and a specific reason may not always be able to be diagnosed or specifically treated.

In the vast majority of children with chest pain, the symptoms will eventually go away. A detailed history and physical examination are important in understanding why a child has chest pain and if the discomfort should be—or not be—of great concern. If a cardiac reason is suspected, your doctor will refer you to a pediatric cardiologist for further evaluation.

Assessing chest pain in children

A detailed patient history with a complete review of all the major body systems by your healthcare provider is the most useful part of evaluating chest pain in children. Your pediatrician or pediatric cardiologist will ask questions such as the following:

1. Where’s the pain located?
2. How long has the pain been present?
3. How often does the pain occur?
4. How long does the pain last before going away?
5. Does the pain occur at rest or with exercise?
6. Is the pain associated with an irregular or fast heart rhythm?
7. Have you had any recent illnesses or fevers?
8. Have you had any fainting episodes or passing out (also known as syncope)?
9. Have you had any injuries to your chest recently?

Common causes of chest pain in children

Chest pain in children may be caused by conditions such as the following:

• 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, or difficulty swallowing
• Psychogenic – Anxiety
• Idiopathic – No specific cause that can be found (the most common occurrence)

In rare cases, cardiac causes of chest pain in children may include the following:

• 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

Tests for diagnosing chest pain in children

In children, there aren’t tests 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 (EKG) may be useful if an abnormal heart rhythm is suspected, and an echocardiogram (echo) isn’t generally helpful unless specific cardiac disorders are suspected and may be performed based on the detailed history and physical exam performed by your doctor.