Chest pains in children

Chest pains occur frequently in teenagers but are less common in younger children. Chest pains can be very frightening and cause a lot of anxiety for both children and parents. Most of us equate chest pains to heart disease. Let not your hearts be troubled, however, as heart disease is hardly ever the cause of chest pain in children.

Common causes of chest pain in children

Most persistent chest pains are from a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.

Occasionally, chest pain follows strenuous exercise (e.g., throwing a cricket ball), lifting (e.g., weights or heavy school bags), or work that involves the upper body (e.g., digging). This type of muscle soreness often increases with movement of the shoulders.

Inflammation in the lungs from asthma or lung infections.

Anxiety: chest pain from stress is often dull or non-specific. It worsens with more stress or anxiety. Stress can make chest pain from other causes seem worse.

Costochondritis: an inflammation between the breastbone and the ribs. It is common in adolescent and pre-adolescent females, but can occur in anyone at any age. It causes tenderness over the sides of the breast bone.

Heartburn: due to reflux of stomach contents. It usually causes a burning discomfort under the breastbone.

Most brief chest pains lasting minutes are from harmless muscle cramps or a pinched nerve

Cardiac chest pain is extremely uncommon in children.Some of the causes are:

Pericarditis: an inflammation of the heart lining. It is usually caused by a treatable infection. Typical pericarditis pain is sharp and in the centre of the chest. It may radiate to the shoulders.

Myocarditis is an inflammation of the heart muscle which may cause chest pain. Sitting down or leaning forward sometimes helps the pain. Cough, troubled breathing and fever are common.

Coronary-artery problems like that seen in adults are rare. These can be due to problems your child is born with.

Mitral valve prolapse is a minor abnormality of one of the valves of the heart. The exact cause remains unclear.

What can you do?

For most childhood chest pain you can see your child's regular caregiver or paediatrician. They will examine your child to make sure nothing serious is wrong and allay your fears. In a few cases chest X-rays, electrocardiograms or consultation with a specialist may be necessary.

Seek immediate medical care if:

Your child develops severe chest pain with pain going into the neck, arms or jaw.

Your child has difficulty breathing, fever, sweating, or a rapid heart rate.

Your child has dizziness associated with the chest pains

Your child faints or passes out.

Your child coughs up blood.

Your child coughs up sputum that appears pus-like.

Your child has a pre-existing heart problem and develops new symptoms or worsening chest pain.

Dr Carleene Grant-Davis is a consultant paediatrician and head, Dept of Paediatrics, Cornwall Regional Hospital; email: yourhealth@gleanerjm.com.