When to seek help for a child complaining of chest pain — questions to ask and symptoms to consider.

Story by: Norton Children’s on August 15, 2019

More often than not, a child complaining of chest pain doesn’t suggest a serious problem.

Children, young ones especially, aren’t very reliable when it comes to describing their own pain.

“Most of the time, chest pain in children is not caused by a heart problem,” said Brian J. Holland, M.D., a pediatric cardiologist with Norton Children’s Heart Institute and UofL Physicians – Pediatric Cardiology. “A young child may be able to tell that something in the area of their chest feels uncomfortable, but families often have questions about the heart because the child cannot give more details .”

If a child’s chest pain is accompanied by a fever, trouble breathing, pale appearance, a fast heart rate, or the child ‘passes out’ or ‘blacks out’ – get help immediately. Call 911.

If there’s a family history of Marfan syndrome, call 911.

Chest pain in children can be scary, but is rarely a sign of heart trouble. Consider these questions when your child complains of pain in the chest.

Is the pain brief and sharp? Is it worse when taking in a breath?

• This could be a sign of chest wall pain. A recent injury can be the cause, but often the cause of chest wall pain isn’t known. Muscles and joints in the chest can be sore or strained and become inflamed. The ribs, sternum, back and other bones may be injured.

Depending on the cause, there may not be much that can be done for chest wall pain except nonsteroidal anti-inflammatory medications such as ibuprofen.

Has the child had a cold or persistent cough? What about stress?

• A respiratory infection like a cold or cough can cause chest pain. Stress or anxiety, whether or not there’s a clear cause like start of school or changes in routine, can make the chest feel painful.

Does the pain feel like burning? Does the pain seem to happen after meals?

• Stomach pain or the burning pain of acid reflux can be easy to describe for adults, but they can also happen in children and can be difficult to describe, especially if they are new.

Is the pain in the upper and middle rib area on either side of the breast bone? Is it sharp, an ache, or does it feel like pressure? Possibly affecting one or more ribs? Does it worsen with deep breaths or coughs?

• You should seek medical attention to rule out heart trouble. But the cause may be costochondritis — inflammation of the cartilage that connects the rib to the breastbone. The pain can mimic a heart attack or other heart condition.

Is it a sudden, sharp, intense pain that only lasts seconds or minutes on the left side of the chest? It only happened once or a few times? Is it unaccompanied by physical activity or even happens while resting? Made worse by inhaling, exhaling or moving?

• Precordial catch syndrome could be the cause. Also known as Texidor’s twinge, this common cause of chest pain in children, while scary, isn’t serious. The sudden pain leaves about as quickly as it happens.

The cause of precordial catch syndrome isn’t known and it probably doesn’t have anything to do with the heart. Some physicians suspect muscle cramps or a compressed nerve is the cause.