Health Library

Chest Pain

Chest pain has a variety of sources, and most structures in the chest can cause pain. This includes the lungs, ribs, the chest wall muscles, the diaphragm, and the joints between the ribs and breastbone. Injury, infection, or irritation to any of these tissues can cause chest pain.

Rarely, the heart is the source of chest pain in children.

Common Illnesses that Cause Chest Pain

Chest pain may be a symptom of a serious underlying disease. Fortunately, though, most chest pain in children is caused by an illness. Listed below are some common illnesses that can result in chest pain.

Costochondritis

Costochondritis occurs secondary to inflammation of the "joint" between the breastbone and the ribs. It is common in adolescent and pre-adolescent females, but can occur in anyone at any age.

Frequently caused by viral illness or by frequent coughing, upper respiratory symptoms often accompany this illness. It may last for several weeks.

There may be pain when inhaling or exhaling deeply, but true difficulty in breathing is rare and should cause concern for other illnesses.

The sign of costochondritis is tenderness when pressure is applied over the costochondral joint, which corresponds to the depression on the sides of the breastbone.

Treatment is usually a one- to two-week course of an anti-inflammatory medicine such as Ibuprofen.

Injury

Injury to the muscles and bones of the chest wall can have many causes. Some are obvious such as a direct blow during a sporting event or a fall. Other less obvious causes include heavy lifting, frequent coughing or intense aerobic exercise, which can all cause strain to the rib muscles.

Treatment is usually rest and over-the-counter pain relievers. Consult a doctor when injury causes chest pain that is severe, does not go away, or if your child has difficulty breathing.

Stress or Anxiety

Although few people are willing to believe that stress can cause chest pain, it is common. The pain is often dull and worsens with stress or anxiety.

Common stressors include loss of a relative, school examinations, and "breaking up" with a boyfriend or girlfriend.

Often, stress can make chest pain from another cause seem worse than it would otherwise seem. It is important to learn whether chest pain is the cause of anxiety or the result.

Precordial Catch Syndrome

Precordial catch syndrome is an illness of unknown cause. It occurs mostly in adolescents and is characterized by sudden onset of intense, sharp pain along the chest or back.

The pain occurs only with inspiration (inhaling). A typical episode lasts several minutes and resolves on its own.

The pain can also be "broken" with a forced deep inspiration. Several episodes may occur per day.

Although its cause remains uncertain, precordial catch syndrome has no significant side effects. There is no specific treatment, and the frequency of events usually declines through adolescence.

Acid Reflux

Acid reflux can cause stomach or chest pain. It can feel like a burning sensation below the sternum, though children may not be capable of describing this symptom.

The pain may vary in relation to meals. There are many prescription and over-the-counter medicines available to treat acid reflux.

Cardiac Chest Pain Causes in Children

Unlike adults, chest pain due to a cardiac cause is extremely uncommon in children. Keep in mind that the following conditions are rare as you review the causes of chest pain.

Pericarditis

An inflammation of the heart lining, pericarditis is usually caused by a treatable infection, but can have other more serious causes. Typical pericarditis pain is sharp and mid-sternal and may radiate to the shoulders.

Assuming a sitting position or leaning forward frequently alleviates pain. Cough, trouble breathing and fever are common.

Coronary Artery Abnormalities

May limit the heart's oxygen supply and cause symptoms similar to adults with cardiac chest pain. This can be due to congenital abnormalities (problems you are born with) of the position of the arteries or acquired diseases like Kawasaki disease.

Extreme thickening of the heart muscle and prolonged episodes of fast heart rate can also limit the heart's blood supply. Children may experience a "typical" crushing mid-sternal chest pain that radiates to the neck and chin or to the left shoulder and arm. More likely, children will have less specific complaints.

Trouble breathing and sweating may also occur. Anyone with these symptoms should promptly consult a doctor.

Mitral Valve Prolapse

A minor abnormality of the valve that fills the main pumping chamber of the heart (the left ventricle). It occurs in up to 6% of females and is less frequent in males.

Although mitral valve prolapse is associated with an increased incidence of chest pain, the exact cause remains unclear.

In the absence of other worrisome signs and symptoms, chest pain in patients with mitral valve prolapse tends to run an uncomplicated course.

Arterial Aneurysm

An arterial aneurysm is a stretching and out-pouching of the vessel that can lead to rupture. In children, chest pain from an aortic aneurysm is extremely rare, and it occurs almost always in the setting of other uncommon diseases, particularly Marfan syndrome.

Other Causes of Chest Pain

Other common causes include inappropriate accumulation of air, fluid or swelling in the chest as well as lung infections and asthma. Look for other worrisome symptoms to determine if your child needs prompt evaluation.

Common Questions About Chest Pain

What should I do if my child has chest pain?

Don't panic. Remember, chest pain is usually due to a treatable cause. Heart disease or other serious illness is an unlikely cause.

If your child has severe chest pain or chest pain associated with trouble breathing, fever, sweating or a heart rate greater than 200, you should promptly call a doctor.

If your child does not have these signs, most chest pain can wait for a convenient time to be evaluated. Call your doctor if you are unsure.

If I think my child needs to be evaluated, what kind of doctor should I see?

It is usually better to start with your pediatrician or family doctor rather than a specialist. Most children with chest pain do not require the services of a specialized physician.

Different causes of chest pain fall under the expertise of different types of specialists. If you do need to see a specialist, your doctor can decide which type of doctor is best.

What should I expect at the doctor’s office if my child is seen for chest pain?

The evaluation usually starts with a history of the problem and a physical evaluation. After that, the evaluation may vary depending on the initial findings.

Many children will require no further testing to establish a diagnosis and start treatment. In some cases, chest X-ray, electrocardiograms, breathing studies, or an appointment with a specialist may be necessary.

What if my child specifically says that their "heart hurts?"

For many young children, the heart is the most identifiable organ in the chest, so they use this phrase to denote chest pain of any kind.

The good news is that children are rarely able to distinguish between cardiac and non-cardiac chest pain, so they are unlikely to be correct in laying blame on the heart.

However, once parents and other caregivers hear this phrase, it can be extremely difficult to persuade them that the heart is not the culprit.

Children who complain of "heart pain" should be evaluated like other children with chest pain, with attention paid to severity and associated symptoms.