Monday Medical: Understanding chest pain in kids

Susan Cunningham
For Steamboat Pilot & Today

If your child is experiencing chest pain, take heart: Chances are, it’s not a cardiac issue.

“Chest pain is a very different issue in adults versus kids,” said Dr. Michael DiMaria, a pediatric cardiologist with Children’s Hospital Colorado who cares for patients at UCHealth Pediatric Heart and Vascular Clinic in Steamboat Springs. “In adults who get chest pain, the assumption is that if they are 65 to 85 years old, it’s probably related to their heart. With kids, cardiac causes are the least common cause of chest pain.”

That doesn’t mean chest pain in kids should be ignored. Below, DiMaria outlines typical causes of chest pain in children and what to do if your child experiences it.

Causes of chest pain in children

For many kids experiencing chest pain, health providers don’t end up finding a cause.

“There are large studies of kids who have come to the ER with the chief complaint of chest pain, and the biggest category is idiopathic pain, which means we can’t figure it out,” DiMaria said.

While tests will be conducted to rule out specific causes, if no issue is found, and the pain resolves on its own, further follow-up isn’t necessary.

The next most common causes of chest pain in children are musculoskeletal issues.

“Sometimes, kids who start a new physical regimen, such as a weightlifting program, can experience chest pain,” DiMaria said. “This can be under-recognized, and families sometimes seek care for their child’s chest pain.”

Chest pain can also be a result of respiratory issues, such as asthma; in most cases, this type of chest pain will be associated with breathing issues. Gastrointestinal issues, such as reflux, can also be a cause of pediatric chest pain — taking an antacid medication can help diagnose and address this issue.

In rare cases, chest pain in children does signal a heart issue, such as congenital heart disease or an infection that affects the heart muscle.

Getting to the root of chest pain

A physical examination and thorough description of the pain can help your child’s medical provider determine the cause of the chest pain. Keeping a diary of symptoms, including where the pain occurs, what it feels like and how severe it is, when it strikes and what makes it better or worse, can be very valuable in making the diagnosis.

Different types of chest pain can often be differentiated based on the symptoms. For instance, pain caused by a respiratory or musculoskeletal issue is typically sharp and reproducible with movement.

“If pushing on the chest reproduces a sharp, stabbing pain, there’s no way this is heart-related chest pain,” DiMaria said.

Reflux, on the other hand, causes a burning pain in the chest that can strike after meals and is often worse when lying down but improves when standing.

Red flags

Seek immediate medical attention any time a child or teenager experiences crushing chest pain or pressure during exercise that improves once the activity stops.

Other red flags include pain that radiates up into the jaw and down in the arms, heart palpitations and exercise intolerance.

In those instances, the child should stop exercise and seek medical care immediately.

If an initial evaluation doesn’t reveal the cause of the pain, studies such as an ultrasound of the heart, also known as an echocardiogram, may be needed.

“We can quickly and painlessly get a diagnosis and say whether or not the heart looks normal,” DiMaria said.

If there is an issue with the heart, a host of treatments and procedures can help.

“Kids in general have such awesome outcomes that it’s rare we find something that we’d say is incurable,” DiMaria said.

DiMaria reminds parents not to hesitate to talk with their child’s provider any time there’s a concern.

“Ninety-nine percent of the time or more, it’s not going to be the heart as the cause, and everything’s going to be fine,” DiMaria said. “And even if it’s not the heart, it’s still important to address the child and family’s concerns.”

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at

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