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Chest Pain in Children

Chest pain is the presenting complaint in 6 per 1,000 children who present to pediatric emergency departments or walk-in clinics. Young children are more likely to have a cardiorespiratory cause of their pain, such as cough, asthma, pneumonia, or heart disease; adolescents are more likely to have pain associated with a psychogenic disturbance.

Cardiac Disease

Cardiac disease is a rare cause of chest pain in children. However, myocardial infarction can rarely result from anomalous coronary arteries, and there may be no warning of this condition.

Mitral valve prolapse may cause chest pain secondary to papillary muscle or endocardial ischemia. A midsystolic click.

Cardiac infections are uncommon causes.

Respiratory Conditions

Severe cough, asthma, or pneumonia may cause chest pain because of overuse of chest wall muscles. Crackles, wheezes, tachypnea.

Exercise-induced asthma may cause chest pain, which can be confirmed with a treadmill test.

Spontaneous pneumothorax or pneumomediastinum may occasionally cause chest pain with respiratory distress. Children with asthma, cystic fibrosis, or Marfan syndrome are at high risk.

Pulmonary embolism is extremely rare in pediatric patients, but it should be considered in the adolescent girl who has dyspnea, fever, pleuritic pain, cough, and hemoptysis. Oral contraceptives or recent abortion increase the risk. Young males who have had recent leg trauma also are at risk.

Psychogenic disturbances can precipitate chest pain. These children may present with hyperventilation.

Treatment of Pediatric Chest Pain

Emergency department referral is necessary if the child is in severe distress or has a history of

Referral to a cardiologist is recommended for children with known or suspected heart disease, syncope, palpitations, or

Musculoskeletal, psychogenic, or idiopathic pain usually will respond to reassurance, analgesics, rest, and