Article by Dr Chan Kit Yee, Paediatrician, Special Interest in Paediatric Cardiology SBCC Baby & Child Clinic, Mount Alvernia Medical Centre

Chest pain in children is an experience of pain or discomfort in any part of the chest that can either be sudden and sharp or dull, occurring over short periods or recurrent in nature.

For many children, the heart is the most identifiable organ in the chest so they often use the phrase “my heart hurts” to denote chest pain of any kind. Fortunately, chest pain in children is very rarely due to a heart issue and often arises from a benign and less worrisome cause.

Causes of chest pain in children
Many organs are located in the chest and a problem in any of these can result in chest pain.

Common causes of chest pain include :

  1. Musculoskeletal – Severe coughing bouts and strenuous exercises that uses the upper body can cause sore muscles in the chest wall.
  2. Precordial catch syndrome –A recurrent chest pain commonly experienced by older children and adolescents as a sharp stabbing chest pain below the left breast that lasts a few seconds and is worsened by taking deep breaths. The cause may result from a pinched nerve. Although the pain may recur for years, it is completely harmless with no significant side effects. However, when it occurs too frequently, it can be disabling and cause undue anxiety.
  3. Costochondritis – An inflammation of the cartilage around the junction of the ribs to the breastbone which usually spontaneously resolve with time (Tietze’s syndrome).
  4. Respiratory conditions such as asthma, chest infections, pleurisy (inflammation of the lining of the lungs), air-leaks (pneumothorax) can cause painful and difficult breathing.
  5. Gastroesophageal reflux or heart-burn causes a burning chest pain which is worsened with lying down after eating.
  6. Psychosomatic pain is typically related to stress or excessive anxiety.

Rarely are the causes heart related

  1. Pericarditis (inflammation of heart lining)
  2. Coronary artery abnormalities can be congenital or acquired like Kawasaki’s Disease.
  3. Abnormal thickening of the heart muscle (hypertrophic cardiomyopathy)
  4. Prolonged episodes of fast heart rate
  5. Mitral valve prolapse, an abnormality of the valve that fills the main chamber of the heart (left ventricle).
  6. Aortic (arterial) aneurysm caused by stretching of the vessel leading to rupture is extremely rare and usually occurs in the setting of other uncommon diseases like Marfan syndrome (connective tissue disorder).

Signs or symptoms to look out for when a child complains of chest pain
Parents should pay attention to symptoms which are more persistent and associated with other tell tale signs of something more serious.

Chest pain that warrants medical evaluation would include those associated with exercise, irregular or fast heart beat, dizziness, syncope or fainting. These symptoms may indicate an underlying heart problem.

A paediatrician should be consulted if:

  • The child looks sick
  • There is a history of underlying heart disease
  • There is difficulty in breathing
  • Taking a deep breath makes pain worse
  • Chest pain is severe
  • The heart is beating very rapidly
  • The child feels faint or dizzy
  • The chest pain is unexplained
  • Pain follows a direct blow to the chest.
  • The child feels weak and is unable to stand or move properly.

Management of children with chest pain
Quite often, a careful history and physical examination is all that is required to identify the cause for the chest pain. Musculoskeletal pain can be treated by supportive measures, rest and anti-inflammatory medicine.

The most common cause for recurrent stretching chest pains which can go on for years is the precordial catch syndrome. Daily exercises sometimes reduce these sudden sharp pains. There is no specific treatment and the frequency of events usually declines through adolescence.

Sometimes tests may be needed such as an electrocardiogram (which checks the rhythm and can detect abnormal muscle thickness), and echocardiography (heart scan). An exercise test may be helpful if the chest pain is associated with exercise or in the context of underlying structural cardiac disease.

Performing these tests to exclude a cardiac cause may itself be therapeutic for those who are anxious and worried and to reassure parents if the child intends to participate actively in sports.

 

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