6 Questions to Ask When Your Child Complains of Chest Pain

I see this scenario quite frequently in cardiology clinic. Generally speaking, about a quarter of my new patient visits complain of the following set of symptoms at their appointment:  chest pain lasting for several months, maybe 2-4 times a week, for less than 10-20 seconds at a time, at a moderate intensity, sometimes with activity, but more often not. And the child just recently told his or her parents about it.

Understandably, the parents are worried.

But the good news is that while it’s pretty common for children to say that their chest hurts or even that their “heart hurts,” it’s rarely caused by heart disease.

Most kids will complain of chest pain sometime between age 7 and their teenage years, but thankfully, it will be caused by an underlying heart condition in less than 1% of them. More frequently it is related to a viral illness, stress, or most commonly, musculoskeletal pain.

It is my hope that this information will give parents a little peace of mind: the pain manifesting in your child’s chest is rarely caused by heart disease. But I also understand how concerning it can be for parents, and sometimes further investigation may be necessary to narrow down the cause. So where should parents start?

I suggest answering the following questions:

  1. Has my child been sick recently?
    One of the more common causes of chest pain in children is from costochondritis. This is a condition characterized by inflammation in the joint between the breastbone and the ribs, typically caused by a viral illness or frequent coughing. Costochondritis is not concerning, but in some cases it can be long lasting and your child may need a prescription anti-inflammatory to get rid of it.
  2. Was my child injured recently?
    If your child was hit in the chest during a sporting event or even a fall, this could be a more obvious cause of the chest pain. However, even heavy lifting, frequent coughing, or intense aerobic exercise can strain the rib muscles and cause chest pain. You’ll want to contact your pediatrician if the pain is severe, persistent, or associated with difficulty breathing.
  3. Is my child stressed?
    While it might be difficult to imagine a 7-year-old being stressed, school pressures and the loss of a loved one, for example, can all contribute to feelings of stress. What may be even more surprising is that stress can cause chest pain. While chest pain caused by stress is harmless – it’s really no different than a stress-related headache – the duration of the pain is understandably worrisome for parents.
  4. When does it hurt?
    Does it hurt when your child is sitting down, or only when he or she is active? Chest pain from non-cardiac causes usually happens both when a child is at rest and when they are active. My first question is often whether the pain occurs during gym class or while watching TV. Chest pain that only happens with or immediately following moderate to vigorous activity, such as while running and playing competitive sports, is a different matter which does warrant further medical investigation.
  5. How long has it been hurting?
    Has it been going on for months or even years? If yes, then it is almost certainly not caused by heart disease. Chest pain caused by cardiac disease is either so severe that no child could cover it up or ignore it, or it is progressive and associated with other problems such as passing out or worsening fatigue, that it would be highly unusual for the symptoms to continue over several months. However, non-cardiac chest pain is the very opposite; it can often by ignored, is not associated with other concerns, and often just lingers in the background.
  6. How painful is it? Mild-to-moderate or severe?
    Typically mild-to-moderate chest pain is not related to the heart, and isn’t a cause for concern. However, the more concerning chest pain is when the pain is sudden and severe. Typically it will hurt so bad that your child will not want to go to school and will look like he or she is struggling with the pain. This kind of pain is most often caused by pericarditis, which is an inflammatory condition of the heart. Thankfully, pericarditis is very rare. But what’s interesting about it is that it’s the most common reason that a child’s chest pain is related to the heart. If your child has sudden onset of severe chest pain that is continuous and often occurs around the same time of an illness – contact your child’s pediatrician that same day.

The vast majority of the time, chest pain in children is not related to the heart. While there is no single medical history question or medical test that can determine the source of chest pain, hopefully the six questions discussed above can help parents and teens narrow down what’s potentially worrisome and what’s not. If you have any concerns at all, schedule an appointment with your pediatrician, and have your answers to the above questions ready. They will help steer your pediatrician in the right direction.

Editor’s note: For more frequent heart and health-related thoughts, follow Dr. Madsen on twitter: @MadsenNicolas

Dr. Nicolas Madsen

About the Author: Dr. Nicolas Madsen

Nicolas Madsen, MD, is a cardiologist at Cincinnati Children’s Heart Institute, with special interest in the prevention of cardiovascular disease. He is focused on research and community outreach programs to find better ways to screen and educate children and adolescents regarding their risks for heart disease or sudden cardiac arrest.

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Comments

  1. Deb June 06, 17:38
    My grandson is 13 and occasionally complains of burning in his chest. Of course I'm a worrying grandmother. He also had some spells of dizziness while playing basketball this year. He has mentioned a couple of times that "it was hard to breathe". His mother took him to the family Dr. and they said that it was probably dehydration . Can someone please put this grandmother's mind at ease. I have watched Dr. Madsen's video , but I am still not certain with his symptoms. Thanks
    • Rachel Camper
      Rachel Camper June 08, 08:40
      Hi Deb, It is difficult to offer perspective on your grandson's health in this format (Q&A on a website, without the benefit of having all necessary information). If you still have concerns about your grandson, getting another doctor's thoughts may offer peace of mind.
    • bryan October 30, 04:41
      he might have what i have which is significant anxiety, go read up on it. its not deadly but effects the upbringing and cause mental illness
  2. rosie June 23, 18:26
    thanks for putting me at ease my 11 year o9ld complains frequently but he is a rough boy and maybe pulled a muscle.
  3. katie2704 June 27, 06:55
    Thank you for this - as the parent of a child with a hear murmur who has a tendancy to panic it is the most reassuring and informative article I read on the subject of chest pain in kids
  4. angel July 19, 03:19
    i have a 14 yr old son, at birth he had a murmur which doc said was ok enough to be discharged and sent home,but recently he complains of severe chest pains and he is quite big in built compared to other 14 yr olds, he was born at 4.5kg,my sugar levels were very high during pregnancy and five years after birth i became diabetic, please help me put my mind at ease as a mom about my son
    • Rachel Camper
      Rachel Camper July 19, 09:38
      Hi Angel, If you haven't already, please watch Dr. Madsen's video at the top of this blog post, as it may help give you peace of mind. If you are still concerned, a visit to your child's regular doctor is never a bad idea.
  5. Pradip August 04, 11:11
    Hi my son is suffering from instantaneos chest pain for a couple of second since last 3/4 days.It's once/twice in a day with little bit breathing thru mouth. Should i worried about it?
    • Rachel Camper
      Rachel Camper August 04, 15:28
      Hi Pradip, I'm sorry to hear that your son is having chest pain. If you haven't already, please watch Dr. Madsen's video at the top of this post. His explanation about what's concerning and what isn't might be helpful in your situation. If you're still concerned, a trip to his doctor is never a bad idea.
  6. Annie August 04, 15:01
    I have a 16yr boy who practices sports and weight lifts. While practicing his warmup running for his football practice has been complaining of pain on his left side like higher than where the ribs are. It comes when he is running or jogging , and will go away after a while. Does not feel any pain during the rest of the practice or the rest of the day. He was weight lifting , not a lot of weight, before practice. Says he did not notice any pain while weightlifting. Has stopped the weight lifting just in case.
    • Rachel Camper
      Rachel Camper August 04, 15:31
      Hi Annie, You might consider watching the video at the top of this post with your son. Dr. Madsen walks through symptoms that are concerning and not concerning, and it might help you decide if a trip to his doctor is warranted.
  7. Kayla August 06, 21:00
    My 13 year old daughter is complaining about her lower left side of her chest hurting, she says that it lasts for about 3-4 minutes and it is hard for her to breath when it occurs. What should I do to help her reduced the pain when it happens?
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author August 10, 16:02
      Hi Kayla, Sorry to hear that your daughter is having this left sided chest pain. Given the description, this sounds like musculoskeletal pain. I imagine it is hard for her to breath because of the pain, as deeper breaths cause more movement of the chest wall itself. The duration (3-4 minutes) is too short for things like ibuprofen to make much of a difference. Have you tried a warm pack on the area? That would at least reach the target while she is having the pain. However, if the pain is quite frequent or increasing in intensity, it might be wise to discuss this with her doctor to sort out if other causes (non-heart related) are possible. Hope that helps.
  8. katytrack August 09, 01:48
    I am a 15 year old elite athlete. All summer I have trained 4-9 hours a day outside on the track. I was born with two holes in my heart which the doctors said healed completely. About 8 months ago, I will just be laying in bed and suddenly have, as Dr. Madsen described, sharp stabbing pains in the chest. Usually I just blow it off like it's no big deal but tonight I experienced more pain than just in my chest area. My chest and left shoulder seemed to have seized up at the exact same time. I was with my mother and she thinks it is just acid reflux because I also have an ulcer. I personally don't think my heart problem was ever solved. What should I do?
    • Rachel Camper
      Rachel Camper August 09, 15:38
      Hi Katytrack, If you have any concerns at all, scheduling an appointment with your doctor for peace of mind is never a bad idea.
  9. crystal August 19, 09:08
    My daughter is 11. she has been complaining of a headache, dizziness, a very mild temp and chest pains. Last night the chest pain woke her up. Do you think this is stress starting the new school year or something more?
    • Rachel Camper
      Rachel Camper August 21, 05:50
      Hi Crystal, If you haven't already, please watch Dr. Madsen's video at the top of this post. It might be helpful in helping to assess what's worrisome and what isn't. If you still have concerns, a trip to your daughter's doctor for peace of mind is never a bad idea.
  10. Wendy August 20, 08:22
    My 10 year old granddaughter has been getting pain in the centre of her back and in the centre of her chest at the same time. This has been happening on a daily basis whether she is active or resting. She has been under a lot of stress lately and has also been suffering from a cold. She is slightly overweight and tall for her age. She is also an early developer. Should I get her tested for cholesterol? Are there any other tests I should get done for her?
    • Rachel Camper
      Rachel Camper August 22, 07:38
      Hi Wendy, It's hard to say in this format what tests would be appropriate for your granddaughter. I recommend watching Dr. Madsen's video at the top of the post and then utilizing the answers to his questions to determine if a trip to her doctor is warranted.
  11. Mica August 21, 08:15
    My daughter is 10 and she complains of chest pains and her heart only at night when its bedtime. Should this be a concern for me?
    • Rachel Camper
      Rachel Camper August 22, 07:35
      Hi Mica, I am sorry to hear that your daughter is having chest pain. If you haven't already, you might want to watch Dr. Madsen's video at the top of this post with your daughter. He explains what is potentially worrisome and what isn't. If you're still having concerns, a trip to her doctor is never a bad idea.
  12. Jackie August 28, 21:32
    Hello, my son is 15 years old. He has a concave chest wall. He has been complaining and has been diagnosed with anxiety and depression. He says now that his " chest hurts all the time". He says anxiety makes it " hurt worst". Should I push for further evaluation of his heart? The pediatrician says he could be candidate for chest wall device to improve concave chest. He just started Zoloft and has already tried celexa for the anxiety and depression. I just worry there may be underling issue or is is this all anxiety.
    • Rachel Camper
      Rachel Camper August 30, 08:57
      Hi Jackie, If you continue to be concerned, checking in with your doctor is never a bad idea.
  13. nana September 19, 18:08
    my daughter is 9 years old and today she was complaining in a pain in her chest, i took her to the doctor and she said i might be the cartilage since when she press on her chest , she felt some pain. It is the first time that something like that happen to her, she scares me to death , but the pain is not that severe. what do you think it is?
    • Rachel Camper
      Rachel Camper September 21, 12:34
      Hi nana, If you haven't already, please watch Dr. Madsen's video at the top of this blog post. It might provide you with some peace of mind.
  14. NyanCat October 01, 20:15
    This has been going on for years, it doesn't matter if I'm being active or sitting on the couch, my heart hurts randomly, me and my mom have went to doctors, but they do not notice anything they just say I'm fine. The pain isn't bad enough for me to have to go home for school or anything, but I usually put my hand on my heart and breath deep breaths until it goes away. I am 10 and I would appreciate and answer, thank you.
    • Rachel Camper
      Rachel Camper October 03, 06:33
      Hi NyanCat, If you haven't already, please watch the video at the top of Dr. Madsen's blog post. It may give you peace of mind about what's concerning and what isn't.
  15. Sam October 25, 20:22
    My friend is a 16 year female. Recently she has experienced chest pain only with exertion. Even just walking. She was sent for exercise evaluation which found nothing and cardiac evaluation which found a leaky mitral valve but the dr wasn't concerned. The family feels at a loss and aren't sure what direction to move in. Any thoughts and advice are appreciated. Thank you
    • Dr. Nicolas Madsen
      Dr. Nicolas Madsen Author October 26, 14:45
      Hi Sam – It’s nice of you to help your friend. It sounds reassuring that your friend has seen a cardiac specialist who was not too concerned about the chest pain. While chest pain with exertion only is a trigger to a cardiac evaluation, thankfully it does not mean that something is necessarily wrong with the heart in a fashion that is dangerous or threatening. Most of the time, chest pain with exertion only is caused by something other than the heart. However, it sounds like the doctors discovered a leaky valve. While it is impossible for me to comment too specifically on this without the data and images, what I can say is that mild degrees of leakiness of valves is common. When the leakiness (or backwards flow) is mild, it does not usually cause harm (and certainly will not be the cause of chest pain). If your friend is still worried, it is always OK to seek a formal second opinion from another specialist. Sometimes that is all that is needed to provide the necessary reassurance. Hope that helps.
  16. Sammie November 04, 01:09
    My sixteen year old daughter is complaining of chest pain. She says that in the middle of her chest, it feels like something is heavy in her chest or something is squeezing her chest. She says she feels very weak and the pain in her chest is discomforting. She is obese for her age, but she is healthy and maintains a healthy diet and is tall. I checked her blood pressure and it's high though. What should i do?
    • Rachel Camper
      Rachel Camper November 04, 04:48
      Hi Sammie, If you haven't already, please watch Dr. Madsen's video at the top of this post. It may provide some peace of mind. If you still have concerns, a trip to her doctor is never a bad idea.
  17. dymelza November 07, 23:25
    my 12 year old was in the supermarket and got a sharp long pain that lasted about 15 minutes in the center of his chest, he was brought to tears, he says this has happened 3 times now, should i be worried?
    • Rachel Camper
      Rachel Camper November 08, 06:32
      Hi Dymelza, If you haven't already, please watch the video at the top of the post. Dr. Madsen outlines what is worrisome and what isn't. It might help give you peace of mind. If you continue to be concerned, a trip to your child's doctor is never a bad idea.
  18. Sophie November 22, 20:39
    Hi, I am 15 years old and for the past 2 years I have had chest pains, mainly toward my left side, and shoulder pain, once again, mainly toward my left side. When I first started feeling the pains I went to the doctor, and they diagnosed me with Costochondritis. She said that my joints feel tender and when she pressed on them it hurt. So when I searched on the internet about the condition, I saw that it usually only lasts a week or 2. I am a vegetarian and I think I lack in iron, if that could have anything to do with it... but the pains came before my diet changed. It usually doesn't hurt when I am exercising. However, sometimes when I take a deep breath in there is a sharp pain. Usually when the pain comes I would press down on where it is, which is usually from the very side of my rib, or my shoulder, or just below my breast, and then the pain would be ok, which makes me think that it has something to do with my ribs/bones. I am not sure but this has brought me a lot of nervousness over the past two years.
  19. Barbie November 26, 10:23
    My 20 year old daughter just started complaining of left sided chest pain radiating to the left part of her upper back, she says it hurts to take a deep breath, she is on birth control and she does have anxiety, my concern is a possible blood clot, as suggestions?
    • Rachel Camper
      Rachel Camper November 28, 07:20
      Hi Barbie, If you have concerns, a trip to your daughter's doctor is never a bad idea, especially for peace of mind.
  20. hayley November 29, 05:30
    Hello my daughter started complaining of not being able to breathe properly about five days ago. The school called me as she has felt unwell at school. I went to the GP who gave me an inhaler to try over the weekend, this makes absolutely no difference. He mentioned that she has been on nitrofuratoin due to UTIs and this can affect the lungs but he was hoping it was not the cause. We were to go back in two weeks if no improvement. Its only been five days. She is not obviously struggling to breathe and can do most things but doesn't feel like it. This morning she said it feels like someone is stabbing either side of her lungs. What should I do? many thanks for any help or advice
    • Rachel Camper
      Rachel Camper November 30, 13:18
      Hi Hayley, I'm sorry to hear that your daughter is not feeling well. It would be difficult for Dr. Madsen to give you specific advice via this format. If you continue to be concerned, a follow-up appointment or second opinion is never a bad idea.