Chest Pain in Children: 6 Questions for Parents to Ask

6 Questions to Ask When Your Child Complains of Chest Pain

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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 be 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.

Read about potential ways to help your child find relief from chest pain in this related blog post.

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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. Annie September 08, 10:15
    Hi! I’m a 13 year old girl and have noticed chest pains that come and go since I was 12. I can only find sources of temporary relief. I’ve spoken with my nan about it. The chest pain comes and goes in random severity, and stopped for a while, then a few weeks ago - ouch! Back it came and now it will not go away! I had very bad gastroenteritis 2 months ago. It comes on multiple times in the day, and I’m really worried! What should I do?!
    • Rachel Camper
      Rachel Camper September 17, 12:55
      Hi Annie, I am sorry to hear that you have been experiencing chest pain. If you haven't already, please watch Dr. Madsen's video at the top of this post. You might even want to watch it with your nan to help determine if your symptoms warrant a trip to the doctor for peace of mind.
  2. Freddie February 03, 11:40
    Hi! I'm a fourteen year old girl and I have been experiencing chest pain for half a year. It's usually feels like a pressure on the left side of my chest but sometimes short pain on both sides, I can also feel shorten of breath sometimes. I'm really worried about it sometimes and I mostly feel it when I'm still watching TV or just in generel after I've come home from school. What should I do?
    • Rachel Camper
      Rachel Camper February 05, 05:25
      Hi Freddie, If you haven't already, please speak with your parents about your chest pain. It might be a good idea to watch Dr. Madsen's video together to help determine what symptoms are worrisome and warrant a trip to your doctor.
  3. Tia February 19, 23:47
    Hello, I am 12 years old and I occasionally have chest pain. But most of the time I’ve noticed that recently it’s like my rib is popping. It can hurt a bit, and cause a short breath.
    • Rachel Camper
      Rachel Camper February 27, 11:00
      Hi Tia, I am sorry to hear that you are experiencing chest pain. If you haven't already, please talk to your parents about this. It might be a good idea for you to watch Dr. Madsen's video together to help determine which symptoms may be worrisome and warrant a trip to your doctor.
  4. Molly March 11, 15:51
    Hello, my 10 year old boy has been hitting his chest every so often with his fist. I asked today why hes been doing that, for approximately the last month, and he said his chest hurts and also said both undersides of his wrists hurt too and he takes his thumb to give them a circular rub to make them feel better. I'm worried what this could be? Thanks for the great informative video.
    • Rachel Camper
      Rachel Camper March 18, 05:35
      Hi Molly, I reached out to Dr. Powell, and here is his response: Thank you for the question Molly. I agree with you that this is concerning behavior. At 10 years old, children can respond to pain and stress sometimes different then we would. From a heart standpoint I am reassured that the pain is improved with pressure as heart pain is inside the rib cage and is not improved or worsened by touch. I think the next step should be a visit with his pediatrician so that he or she can help look into some of the most common causes of chest pain. Hopefully they can give you some answers and he starts feeling better soon.