- Chest pain in children is usually benign, but preadolescent children are more likely to have a cardiorespiratory source.
- Chest pain with fever, dyspnea with exertion, fatigue, and an examination that reveals distant heart sounds or a friction rub should alert the physician to consider myocarditis or pericarditis.
- Asthma and pneumonia are common causes of chest pain in children.
- Electrocardiogram, chest radiographs, and cardiac enzymes should only be ordered when there is a history or physical examination suggesting a cardiopulmonary etiology for chest pain in children.
Chest pain is a worrisome symptom that often causes parents to bring their child to the emergency department (ED) for evaluation. The rate of pediatric patients presenting to the ED with a complaint of chest pain is 3 to 6 for every 1000 patient visits.1,2 In the majority of cases, the etiology of the chest pain is benign, but symptoms are distressing enough to cause 27% to 30% of children to miss school.2,3
The clinical presentation of the pediatric patient with chest pain varies greatly. The average age of presentation is 10 to 12 years, with an equal distribution between sexes.1–4 Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas the chest pain of an adolescent patient is more likely to be of psychogenic origin.1,3
The duration of the chest pain in the majority of patients is either acute or subacute in onset.1,3 Patients that present with a complaint of chronic chest pain (>6 months duration) usually have idiopathic or psychogenic chest pain.3,4
Children often have difficulty localizing and qualifying their pain. In instances where the child is able to indicate a location for their chest pain (e.g., right-sided, left-sided, and sternal), no specific relationship to a particular diagnosis or diagnostic category has been found.1–3 The description of the pain (e.g., sharp, dull, and aching) also shows no relationship to the actual diagnosis.3
The differential diagnosis for pediatric chest pain is extensive. The diagnostic categories with precipitating clinical causes are listed in Table 8–1.
Table 8-1. Differential Diagnosis of Chest Pain |Favorite Table|Download (.pdf)
Table 8-1. Differential Diagnosis of Chest Pain
Myocardial infarction or ischemia
Pneumonia ± pleural effusion
Esophageal foreign body
Slipping rib syndrome
Precordial catch syndrome (Texidor's twinge)
No organic or psychologic cause identified
A cardiac cause for pediatric chest pain is found in 4% to 5% of cases presenting to the ED.1,3 Myocardial infarction is rare in the pediatric ...