Chest pain in children
Pediatric chest pain is rarely cardiac, often benign.
Chest pain in children—including infants, children, and adolescents—is usually not related to the heart. It is identified when the child reports pain or when parents or caregivers notice signs of distress. The condition is fairly common, with many children seen in clinics, emergency departments, and cardiology offices. In most cases, the cause is benign, though some children have serious or life-threatening conditions. A careful physical exam and detailed history are needed to identify possible serious causes. Research on pediatric chest pain is limited, making it hard to create evidence-based guidelines.
The pain is often evaluated in emergency settings and can be distressing for families. Unlike in adults, heart-related causes are rare. The most common reason for an emergency visit is musculoskeletal pain, including costochondritis. This type of pain, due to inflammation or an unknown cause, accounts for 7% to 69% of visits. It is often a diagnosis of exclusion or linked to idiopathic causes. Asthma and other respiratory issues are the second most common, making up 13% to 24% of cases. Gastrointestinal and psychogenic causes each occur less than 10% of the time. Cardiac causes are found in no more than 5% of children. Unknown causes account for 20% to 61% of final diagnoses. Children with cardiac disease are more likely to have acute pain that wakes them from sleep, occurs with fever, or shows abnormal findings on exam. Trauma is associated with chest pain in about 5% of patients. Sudden onset related to vigorous activity or coughing is often linked to asthma. Infection with *Haemophilus influenzae* can also cause chest pain.
Because most causes are not life-threatening, parents and children are often reassured that the cause can usually be found. If dehydration is suspected, an intravenous line with saline may be given. Diagnostic testing may or may not be done, especially for chronic pain. If no obvious cause is found, testing often starts with a chest X-ray and an electrocardiogram to check for pulmonary or cardiac issues.
Quick Facts
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Facts from the source article.
Lore & Background
Chest pain in children is a common complaint leading to visits in ambulatory clinics, emergency departments, hospitals, and cardiology clinics. Unlike in adults, the cause is rarely cardiac. Musculoskeletal pain, including costochondritis, accounts for a significant portion of emergency visits, with estimates ranging from 7% to 69%. Asthma and other respiratory causes are the second most common presentation, comprising 13% to 24% of cases. Gastrointestinal and psychogenic causes each occur less than 10% of the time. Cardiac causes are identified in no more than 5% of pediatric patients. Unknown causes are estimated to account for 20% to 61% of final diagnoses.
Reader's Guide
Chest pain in children is a significant clinical concern because it causes distress for both children and parents, yet most cases are benign. The evaluation requires careful physical examination and detailed history to identify serious causes, which are rare. Red flags for cardiac origin include a history of congenital or acquired heart disease, fainting with exertion, abnormal blood coagulation, high cholesterol, family history of sudden death under 35 or early coronary artery disease, family arrhythmias like Brugada or Long QT syndrome, implanted defibrillator, connective tissue disease, or cocaine/amphetamine use. Studies of pediatric chest pain are sparse, making evidence-based guidelines difficult to create. Treatment focuses on reassurance, bronchodilators for asthma-related pain, and supportive care for distress. The condition underscores the importance of thorough history-taking, which is often absent in emergency visits.
Did You Know?
- Chest pain in children is primarily identified by the observance or report of pain by the infant, child, or adolescent.
- Cardiac causes of pediatric chest pain are found infrequently, not identified more than 5% of the time.
- The median age of pediatric patients complaining of chest pain is 12 to 13 years old.
- A small study in Turkey found that 59% of pediatric chest pain patients had pain lasting more than one month.
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