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Chest pain is a common symptom in pediatrics. It often causes significant anxiety and concern for patients and families. Although cardiac etiologies are often the principal concern for families, pediatric chest pain is rarely caused by cardiac disease (0%–5%).1-3 More common causes involve the pulmonary, gastrointestinal, or musculoskeletal systems. Hospitalists caring for patients with chest pain must be able to utilize a thorough history and physical to determine benign from organic disease among the long list of differential diagnoses (Table 20-1).
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Acute chest pain is much more likely to have an organic etiology than chronic pain, which is more likely to be musculoskeletal, psychogenic, or idiopathic. Table 20-2 outlines some of the common findings and their associated diagnoses in pediatric chest pain. It is often difficult for younger children to accurately articulate the location, severity, or quality of chest pain. For example, younger children may complain of chest pain when what they’re likely experiencing are palpitations. It is important to consider the gastrointestinal organs due to the proximity of the epigastric area to the sternum. Modifying factors such as relationship to exercise, positional change, effect with ...