Chest pain is a frequent complaint in children, with the highest incidence in the early teenage years. Musculoskeletal structures of the chest wall are the common culprits; cardiac reasons are rarely the cause but should always be considered.
Causes of chest pain in children
- Non-specific (idiopathic) chest pain is the most common cause of chest pain in children and young adolescents. It is described as sharp, localized non radiating chest pain which lasts a few seconds to a few minutes. It may be exacerbated by deep breathing and by deep palpation. The costochondral junctions are not tender to palpation.
- Costochondritis usually presents as unilateral chest pain involving a few costochondral junctions; these are tender to deep palpation.
- Pericarditis causes severe chest pain that often intensifies when the patient lies down and lessens when the patient leans forward. The EKG may show ST segment elevation.
- Herpes zoster chest pain is frequently associated with typical skin eruptions.
- Pneumothorax causes abrupt severe chest pain.
- Other non-cardiac causes of chest pain in children include pneumonia, bronchitis, sickle cell crisis, trauma, muscle strain and asthma.
- Cardiac causes of chest pain in children include hypertrophic cardiomyopathy, aortic stenosis, pericarditis, arrhythmias, mitral valve prolapse and coronary insufficiency. The causes of coronary insufficiency include Kawasaki disease, Williams Syndrome, anomalous origin of the coronary arteries and coronary arteriovenous fistulae
Evaluation of chest pain in children
A good history, including a family history, may help exclude serious causes of chest pain. Benign chest pain is not associated with other symptoms. Chest pain with exercise should raise the suspicion of potentially serious causes and warrants further investigations especially if associated with light-headedness or pre-syncope.
An EKG should be done for any patient with chest pain. Further investigations including echocardiography or other imaging modalities depend on the history and physical examination.
The management is directed to the underlying cause. Musculoskeletal chest pain and costochondritis are managed by reassurance and non-steroidal anti-inflammatory medications. Exertional asthma is managed with bronchodilators.
more info: Yildirim A, et al.Chest Pain in Children. International Pediatrics Vol. 19, No. 3/2004 175
more info: Chest Pain from Cincinnati Children's