Chest pain is a common complaint in children.  Unlike adults, chest pain in kids is rarely due to the heart. The most common causes of chest pain in children are due to muscle and bone pain of the chest wall.  Respiratory conditions such as asthma, cough, or pneumonia may also cause chest pain.  Gastroesophageal reflux (GER) and inflammation of the esophagus may also cause discomfort in the chest. The cause of chest pain is often determined by the history and an examination of the chest. Pain that is worse with movement or with pressure on the junction of the ribs and sternum is likely musculoskeletal in origin. The treatment of chest pain depends on the cause.

What are the most common causes of chest pain in children? 

Musculoskeletal 

• Chest wall muscle strain 
• Costochondritis
• Direct injury 

Gastrointestinal 

• Gastroesophageal reflux (GER) 
• Esophagitis
• Swallowed foreign body 
• Irritation in the esophagus or stomach from medications

Respiratory 

• Asthma 
• Cough 
• Hyperventilation (often caused by anxiety) 
• Vocal cord dysfunction 
• Pneumonia
• Pneumothorax

Cardiac (Rare in children)

How is the cause of chest pain determined? 

History 

• Severity 
• Frequency 
• Quality 
• Worse with movement?
• Worse in certain positions?
• Worse with deep breathing?
• Worse with exercise? 
• Worse with spicy or acidic foods? 
• Unusual heart rhythm?
• Associated symptoms or diseases?

Physical exam

• Is it painful for your physician to press on the breastplate or ribs?
• Tenderness at the site of the connection of the ribs and breastplate is most likely due to costochondritis.
• Pain worse with movement is likely due to chest wall pain. 
• Is the child ill-appearing? 

Imaging

A chest xray is useful for determining if there are a lung abnormalities. 

Other tests

Cardiac testing is rarely necessary in children with chest pain however electrocardiogram (EKG) may help determine if there is a rhythm abnormality or heart strain.  This may be especially useful in those children who describe a feeling of heart racing, heart skipping beats, or feeling like passing out. 

What are some indications that heart pain may be serious? 

Red flags

• Syncope 
• Dizziness 
• An ill-appearing child 
• Difficulty breathing 
• Worsening pain with exercise 
• Recent drug abuse 
• Recent foreign body ingestion 
• An abnormal heart rhythm

How is chest pain treated?

Treatment for chest pain depends on the cause. 

Gastroesophageal reflux is treated with antacids. 

Chest muscle, bone, or cartilage pain may respond to anti inflammatory medications and rest.  Remember, however, that anti inflammatory medicines (NSAID'S) may worsen gastroesophageal reflux and gastritis (inflammation in the stomach). 

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