Chest pain is something that not only adults experience, but children too! The good news is most often, the source of chest pain in children is not related to any type of heart problems. An article in the Pediatrics Journal reported that in 3,700 children and young adults ages 7 to 22 who presented to the ER with chest pain at Children’s Hospital Boston from 2000 to 2009, only 37 cases, or 1%, showed a cardiac cause of chest pain. Any structure in the chest can cause pain in this area including the lungs, ribs, muscles, diaphragm, and even joints. To a parent, hearing your child complain of chest pain can be very scary. Here is a list of chest pain causes you might find in your children.
Injury: An injury to the chest wall can come from a variety of sources, like a direct blow to the chest, a fall, or injuries related to physical activity, like not warming up properly, muscle strains or fractures. There are lots of muscles in the chest wall, so when they are injured they get inflamed and cause pain. Another less common cause of injury to the chest wall muscles can be from a frequent or severe cough. Sometimes muscle injury in the chest can have a delayed onset, meaning the soreness related to an injury shows up a while after the injury occurred, so making it harder for parents to associate the pain with the injury. Soreness from injury usually is most intense 2 days after the injury.
Costocondritis: This chest pain is caused by inflammation of the joint between where ribs meet the chest bone. This is more common in adolescents, and preadolescent females, but can occur at any age. This pain is often described as a “sharp” type of pain, that can last from seconds to several minutes and can sometimes get worse when taking a deep breath or when touching over the joint area.
Asthma: Our airways are lined with lots of tiny muscles that help us to move air in and out of our chest, helping us breathe. In patients with asthma these muscles can sometimes get inflamed and result in narrowing of the air passageways, making it harder to breath. Our bodies adapt by using our intercostal muscles (the muscles between our ribs) to help these patients get more air into the lungs. Sometimes overworking of these muscles can cause chest pain.
Gastroesophageal Reflux: This is commonly known as “heartburn” or simply “reflux”. Gastroesophageal reflux is when the acid contents of the stomach move from the stomach back up into the esophagus. There is a muscle that prevents reflux of stomach contents back into the esophagus, called the lower esophageal sphincter, but sometimes this muscle can become a little more relaxed thus leading to backflow of stomach contents into the esophagus. The acid from the stomach is not meant to be in the esophagus, so this causes inflammation, irritation and pain in the esophagus. The esophagus is located in the middle of the chest, so that is why we feel the irritation of the esophagus in the chest.
Precordial Catch Syndrome: This syndrome occurs most commonly in adolescents and has no known cause. It is characterized by sudden intense, sharp chest or back pain that occurs when taking a breath in. These episodes only last a few minutes, and then resolve on its own. This is often worrisome to teens, but this syndrome is not related to the heart, and teens usually grow out of it.
Stress or Anxiety: Just like stress can cause a headache, it can also cause chest pain. Common reasons for stress related chest pain in children and adolescents are loss of a relative, school examinations, “breaking up” with a boyfriend or girlfriend, or upcoming dental visits for example. The child may become upset, stressed, and this may result in chest pain. The pain experienced due to stress is often dull and gets worse with increased stress or anxiety related to an event.
Infections of the Lungs: Pain from infections of the lungs can be caused by a number of issues, like from inflammation of the airways, or a significant cough which may strain chest wall muscles.
Swallowing a foreign body: Kids like to put lots of things in their mouths. A foreign body can cause chest pain as it moves through the esophagus into the stomach, or if it gets stuck in the child’s airway. If the foreign body is stuck in your child’s airway best to get to the emergency room right away.
As previously mentioned, cardiac causes of chest pain in children are rare. Here is a list of possible heart conditions that may related chest pain.
Pericarditis: This is an inflammation of the heart sac that surrounds the heart which can cause fluid to accumulate around the heart. Most often caused by a virus.
Myocarditis: This is inflammation of the heart muscle wall, which help to pump blood out of the heart. Most often caused by a viral infection, although it is a very rare condition.
Arrhythmias: Arrhythmia is an irregular beat of the heart. Usually a child’s heart can beat too fast or too slow. Most often arrhythmias are harmless, but they also can be serious.
Coronary Arteries Abnormalities: Coronary arteries are the main blood vessels that get blood to the heart. If these become blocked they can limit oxygen supply to the heart causing chest pain. Most often blockage is related to congenital abnormalities or abnormal position of these vessels.
Although chest pain in children and adolescents is rarely caused by heart problems, it can still be very concerning to a parent. If you are ever unsure about your child’s symptoms it’s always best to see your doctor or nurse practioner. Call your doctor or NP if your child:
• Looks very sick
• Has difficulty breathing
• Has severe chest pain
• Feels like their heart is beating very fast
• Loses consciousness
• Has a fever
Chest pain related to inflammation or injury of the muscles can be treated with over the counter pain medication like acetaminophen (Tylenol) or ibuprofen (Advil), by applying local heat to the area using a heating pad, or stretching muscles. Treatment of reflux related chest pain can be done by prevention methods, such as avoid overeating, foods that cause increased reflux like chocolate, fatty foods, spicy foods, and carbonated drinks. Sometimes your doctor may prescribe an antacid for reflux.
– Dr. Christina Cesareo and Dr. G Paul Dempsey
[Feature image: Yale Rosen]