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Chest Pain

Chest pain is discomfort a child feels in the upper torso or chest area. The pain can be an unpleasant physical or emotional feeling. It can be different for each child. Unlike adults, chest pain in children is only rarely a sign of a heart problem.

Causes of chest pain

There are many causes of chest pain in children. Chest pain in children may or may not be a sign of tissue damage. Chest pain may include an ache or soreness in the chest wall (skin, muscles, or ribs). However, chest pain can come from the windpipe (trachea) and lungs, the esophagus, the diaphragm, the nerves and spinal cord, and the heart. The nerves from the various parts of the chest cross over each other and enter the spine at different levels. For this reason, it may be difficult for the child to say or show exactly where the pain is. The source of the pain may not be related to the chest at all.

Some of the most common causes of chest pain are:

  • Costochondritis: an inflammation between a rib and the breast bone.

  • Muscle strain or injury.

  • Gastroesophageal reflux.

  • Functional or anxiety-related pain. This is common in teenagers. Symptoms include hyperventilation, lightheadedness, and numbness or tingling around the lips and in the hands and/or feet. Despite not having an identifiable cause, this pain is still real.

  • Exercise-induced asthma, acute bronchitis, or pain from coughing.

Chest pain is rare in children and is not often caused by heart disease

Chest pain in children accounts for less than 1 in 100 of all paediatric emergency room visits. However, it still causes a large amount of anxiety in both patients and their parents.

In most cases, a child’s chest pain comes from a lung infection, a muscle or bone injury, anxiety, or inflammation. Unlike in adults, heart disease is a rare cause of chest pain in children.

Be sure to inform your doctor of any family history of sudden, unexplained deaths, heart disease, exercise intolerance, early cardiac disease, or inflammatory or rheumatic diseases. In many of these rare cases, sudden death is caused by a heart condition that was unknown before the person died.

What your doctor can do for chest pain

The doctor will examine your child. Usually, the cause of the chest pain is identified by the description of the pain and the physical examination. Most of the time, no tests are needed. If the doctor does order some tests, these might include an electrocardiogram (ECG), a chest X-ray and/or blood tests. Based on all this information, your doctor will provide a diagnosis.

Some children with chest pain will need to see a heart specialist. If your child is referred to a specialist, follow the instructions given to you by the doctor until you visit the specialist.

Special groups of children in which chest pain is more worrisome include:

  • children who have already had a heart operation
  • children involved in major trauma, such as a car crash or other severe blow to the chest
  • children with cystic fibrosis
  • children who have sickle cell disease

Taking care of your child with chest pain at home

Treat the pain

Offer your child pain medications such as acetaminophen (Tylenol®, Tempra, or other brands) or ibuprofen (Motrin®, Advil®, or other brands). Putting a warm or cool pack to the sore area may help.

Avoid strenuous activity

If the chest pain is caused by muscle strain, your child should avoid strenuous activities and heavy lifting. He can slowly return to activity based on the amount of pain. Strain caused by a backpack can be reduced by proper fitting. Your child should  carry the backpack on both shoulders, not off to the side.

Further treatment will depend on the cause of the chest pain. Follow your doctor’s instructions.

When to see a doctor

Make an appointment with you child's doctor if:

  • The pain is not going away and/or it affects your child's daily life.

  • Your child has chest pain and a fever.

Go to your nearest Emergency Department or call 911 if:

  • The pain comes suddenly during strenuous activity and/or it is associated with fainting.

  • Your child feels his heart racing, or becomes dizzy or sweaty with the pain.

  • Your child is having trouble breathing or turns blue.

  • Your child appears more sleepy than usual, is weak or irritable, and has a very high fever.

Key points

  • In children, chest pain is only rarely related to the heart.

  • Most children do not need to see a heart specialist.

  • Most chest pains are caused by lung infections, muscle, tendon or bone injury, anxiety, or inflammation.

  • If the chest pain comes with high fever, weakness, heart racing, dizziness, sweating or difficulty breathing, seek medical attention right away.

Christopher Sulowski, MD

Janine A. Flanagan HBArtsSc, MD, FRCPC

Bruce G. Minnes, MD, FRCPC, ABPEM