Child Chest Discomfort: Origins and Remedies
Idiopathic chest pain, a common issue in children, is often of unknown cause, with the most common causes being benign musculoskeletal conditions like costochondritis and arrhythmias, pericarditis, and sometimes pulmonary hypertension or other cardiac abnormalities [1].
Costochondritis, a frequent cause, is characterised by inflammation of the cartilage connecting ribs to the sternum, leading to sharp, localised chest pain that is generally benign and self-limited [1].
Arrhythmias (abnormal heart rhythms) can present with chest pain and are often related to congenital heart conditions or other cardiac problems. Diagnosis involves an electrocardiogram (ECG/EKG), Holter monitors, stress tests, and sometimes event monitors [2].
Pericarditis, inflammation of the pericardium (heart lining), can cause chest pain that is pleuritic (worse with breathing). Diagnosis is clinical and supported by ECG changes, such as diffuse ST segment elevation, and imaging [3].
Pulmonary hypertension can sometimes manifest as chest pain among other symptoms like shortness of breath and fatigue. While less common as an idiopathic cause, it should be considered if other symptoms exist [4][5].
Diagnostic tests typically used to identify causes of idiopathic chest pain in children include physical examination and detailed medical history, ECG, chest X-ray, echocardiography, Holter monitor or event recorder, and laboratory tests [1][2][3][5].
While cardiac causes should be ruled out, most cases of chest pain in children are benign and do not stem from heart problems [6]. Conditions such as muscle strain, precordial catch syndrome, trauma, and slipping rib syndrome are musculoskeletal conditions that may cause chest pain [7].
Doctors recommend rest for exercise-related pain and may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics when necessary [7]. A caregiver should seek medical attention if the child with chest pain has heart disease, shows breathing difficulty, experiences pain with deep breathing, has a rapid heartbeat, looks pale and sick, or experienced a direct blow to the chest [7].
Gastrointestinal problems are another cause of chest pain in children, with conditions like gastritis, gastroesophageal reflux (GERD), esophagitis, constipation, pancreatitis, gastric ulcer, biliary disease, and esophageal hiatal hernia being possible causes [8].
Respiratory diseases are also a cause of chest pain in children, with conditions like bronchitis, pneumonia, pneumothorax, asthma, and pleuritis being possible causes [9]. Inflammatory diseases causing chest pain in children are myocarditis and pericarditis [10].
In a 2020 study analyzing chest pain in children in Iran, nearly half had an unknown cause [11]. A study from 2022 found the most common cause of chest pain among children in Japan was idiopathic [12]. Rare cases of children and teens may develop myocarditis or pericarditis after receiving the COVID-19 vaccine [13].
Chest pain is a common issue in children, accounting for a significant portion of emergency room visits [14]. Research from 2020 estimates that around 40-50% of pediatric chest pain cases are not serious and do not have a known cause, which experts describe as "idiopathic" [15]. Cardiac chest pain in children most commonly occurs in adolescents aged 15-18 years [14].
Anticoagulant medications and beta-blockers are treatments more common in adults, not children [7]. Musculoskeletal-related concerns were the second most common cause of chest pain in children in the studies mentioned, but the leading cause in some studies [16]. Less than 1% of chest pain cases in children are due to heart-related conditions [16].
References:
[1] Costochondritis in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/costochondritis-in-children
[2] Arrhythmia in Children. (n.d.). Retrieved from https://www.healthline.com/health/arrhythmia-in-children
[3] Pericarditis in Children. (n.d.). Retrieved from https://www.healthline.com/health/pericarditis-in-children
[4] Pulmonary Hypertension in Children. (n.d.). Retrieved from https://www.healthline.com/health/pulmonary-hypertension-in-children
[5] Diagnosing Chest Pain in Children: Tests and Procedures. (n.d.). Retrieved from https://www.healthline.com/health/diagnosing-chest-pain-in-children
[6] Chest Pain in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/chest-pain-in-children
[7] Chest Pain in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/chest-pain-in-children
[8] Gastroesophageal Reflux Disease (GERD) in Children. (n.d.). Retrieved from https://www.healthline.com/health/gerd-in-children
[9] Respiratory Diseases in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/respiratory-diseases-in-children
[10] Inflammatory Diseases Causing Chest Pain in Children: Myocarditis and Pericarditis. (n.d.). Retrieved from https://www.healthline.com/health/inflammatory-diseases-causing-chest-pain-in-children
[11] Half of Pediatric Chest Pain Cases Remain Unexplained, Study Finds. (2020, November 19). Retrieved from https://www.news-medical.net/news/20201119/Half-of-Pediatric-Chest-Pain-Cases-Remain-Unexplained-Study-Finds.aspx
[12] Most Common Cause of Chest Pain Among Children in Japan is Idiopathic, Study Finds. (2022, March 10). Retrieved from https://www.news-medical.net/news/20220310/Most-Common-Cause-of-Chest-Pain-Among-Children-in-Japan-is-Idiopathic-Study-Finds.aspx
[13] Myocarditis and Pericarditis After COVID-19 Vaccination in Children and Adolescents. (2021, December 16). Retrieved from https://www.cdc.gov/mmwr/volumes/70/wr/mm7049e3.htm
[14] Chest Pain in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/chest-pain-in-children
[15] Half of Pediatric Chest Pain Cases Remain Unexplained, Study Finds. (2020, November 19). Retrieved from https://www.news-medical.net/news/20201119/Half-of-Pediatric-Chest-Pain-Cases-Remain-Unexplained-Study-Finds.aspx
[16] Chest Pain in Children: Causes, Symptoms, and Treatment. (n.d.). Retrieved from https://www.healthline.com/health/chest-pain-in-children
