Chest Pain in Children

A COMMON COMPLAINT: My 10-year old son has complained several times about "his heart hurting." When I question him about the location of the pain, it is in his breastbone. He does not have difficulty breathing and has no history of heart problems. Is there anything that I can do for him such as giving him Tylenol or Advil?

THE ANSWER:

This is an example of how kids are so different from adults. If an adult complains of chest pain, it is considered a medical emergency fearing that this is a heart attack. Fortunately in children, this is not the case. As a matter of fact, heart attacks and other cardiac problems are extremely rare in kids. Reassuringly, one study performed in children with chest pain confirmed that in almost all cases both the chest x-ray and Electrocardiogram (ECG) were normal. The most common cause of chest pain in children is "Chest Wall Pain". In other words pain related to the actual ribs or muscles and not the lungs or heart.

Symptoms help distinguish chest wall pain from heart pain

Usually the history and description of symptoms is an important clue to differentiating chest wall pain from pain of cardiac or heart origin. Cardiac pain is usually a feeling of chest tightness or heaviness, with really no specific location. In addition, cardiac pain may radiate to the arms or jaw and is frequently associated with nausea, dizziness or excessive sweating. Heart pain also does not change with respiratory movements or body movements. However, chest wall pain, is made worse or brought on by chest movements such as taking a deep breath or moving around. Also, in contrast to heart pain, chest wall pain is very specific in location. The child usually points exactly to where it hurts and a doctor can actually cause the pain when touching the tender area of the chest.

What causes chest wall pain?

An obvious cause is a recent injury or trauma. Most children with repeated episodes of chest pain, have no history of injury. Although the exact cause is not understood, a common cause of chest wall condition is called "Costochondritis" which usually occurs in pre-adolescents and teenagers; Some experts feel that it is related in some way to puberty. Costochondritis is an inflammation of the joint between the breast bone (sternum) and the ribs. In younger children this "costochondral" area is soft or cartilaginous. With puberty and growth, this soft area calcifies making it harder and for some reason, this area may becomes irritated (or inflamed) resulting in pain and tenderness. When examining children with costochondritis, the doctor can very specifically cause pain by pressing on the "costochondral' junction, where the ribs meet the breast bone.

Treating chest wall pain

There is no specific treatment for costochondritis, except for acetaminophen (Tylenol) as needed. Rarely, especially in girls, this can become a chronic problem called Teitze syndrome, which may need anti-inflammatory medications for a few weeks or more. However in most children the pain is intermittent and eventually goes away. Upon a usual normal medical evaluation, reassuring the child and parents that this is not a heart attack, is probably the best treatment approach as this alleviates the anxiety.