Chest Pain in Your Child: Is it Normal or Something Worse?

Symptom has a non-cardiac cause in 98 percent of pediatric cases
child at doctor office

Contributor: Peter Aziz, MD

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Our society today is more knowledgeable about cardiac symptoms, and most patients seek prompt medical attention, knowing the stakes.

Chest pain during a heart attack is caused by ischemia, or a lack of blood flow to the heart. In adults, chest pain is considered a precursor to a heart attack, and urgent action is warranted.

Fortunately, chest pain in children often has a much more optimistic outlook.

RELATED: Women May Have No Chest Pain During Heart Attack

Pediatric patient numbers

Chest pain is one of the most common causes of unscheduled medical encounters. In patients ages 10 to 21, chest pain accounts for more than 650,000 emergency department and primary care visits.

Chest pain also is the second-most common reason for referral to a heart health. Despite its ever-present nature, chest pain has a non-cardiac cause — meaning it’s not related to the heart — in 98 percent of pediatric cases.

Important signs and symptoms

If your child visits the doctor for chest pain, the physician likely will ask very specific questions about the discomfort. Often, the history alone can be a determining factor of the cause of chest pain, so detailed questions are the most important portion of the visit to the doctor.

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Knowing what the patient was doing, the intensity and location of the pain, the worsening and alleviating factors and the pain duration allows your doctor to narrow down the possible causes of the chest irritation.

For example, a patient describing burning-type pain in the mid-sternum following a spicy meal is likely to have gastroesophageal reflux.

Questions that address symptoms such as passing out and palpitations also can help diagnose possible cardiac causes of chest pain.

RELATED: Heart Palpitations Can Be Scary, But Don’t Always Signal a Problem

First steps in evaluating the pain

The physical examination is another critical piece of the evaluation. As part of the evaluation, your pediatrician will palpate, examine and touch the chest wall with the intention of causing a similar quality of pain.

The ability to reproduce recurring chest pain is a reassuring sign, as it implies that the inflammation stems from the chest wall, not the heart itself. In fact, chest wall pain — or musculoskeletal pain — is the most common cause of chest pain in pediatric patients and is relatively easy to diagnose.

By listening to a child’s heart with a stethoscope, a physician can assess for the presence of structural heart problems as a possible cause of the pain. Cardiac murmurs can indicate the presence of structural heart disease. Luckily, the cardiac examination often is completely normal in otherwise healthy children.

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If the cardiac examination is not normal for some reason, a pediatrician likely will refer your child to see a specialist in pediatric cardiology.

More aggressive evaluation and testing

Testing and laboratory evaluation are directed largely by the presence of positive or concerning findings. If the assessment has no concerning findings, your doctor will not recommend further testing.

If concerns arise, your doctor will refer you for further evaluation, which may include an electrocardiogram or an echocardiogram. Both of these non-invasive tests are aimed at assessing the cardiac rhythm and cardiac structure.

Treatment of chest pain is based, of course, on the underlying cause. Musculoskeletal chest pain, for example, often is treated with either observation or anti-inflammatory medications. Consistent treatment is the most likely to resolve any residual muscle inflammation and often is quite successful.

Other therapies include general treatment strategies for asthma and gastroesphageal reflux, two other common causes of chest pain.

More information
Congenital heart disease treatment guide

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.

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