Children with chest pain present to the emergency department (ED) at a rate of 3 to 6 for every 1000 patient visits.
In the majority of cases, the etiology of the chest pain is benign.
The differential diagnosis is extensive; however, meticulous history and physical examination usually obviates the need for investigations.
Chest pain is a worrisome symptom that often causes parents to bring their child to the emergency department (ED) for evaluation. The rate of children presenting to the ED with a complaint of chest pain is 3 to 6 for every 1000 patient visits.1,2
In the majority of cases, the etiology of the chest pain is benign, but symptoms are distressing enough to cause 27% to 30% of children to miss school.2,3
The clinical presentation of children with chest pain varies greatly. The average age of presentation is 10 to 12 years, with an equal distribution between genders.1–4 Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas the chest pain of an adolescent patient is more likely to be of psychogenic origin.1,3
The duration of the chest pain in the majority of patients is either acute or subacute in onset.1,3 Patients that present with a complaint of chronic chest pain (>6 months’ duration) usually have idiopathic or psychogenic chest pain.3,4
Children often have difficulty localizing and qualifying their pain. In instances where the child is able to indicate a location for their chest pain (e.g., right-sided, left-sided, and sternal), no specific relationship to a particular diagnosis or diagnostic category has been found.1–3 The description of the pain (e.g., sharp, dull, and aching) also shows no relationship to the actual diagnosis.3
The differential diagnosis for pediatric chest pain is extensive (Table 7-1).
TABLE 7-1Differential Diagnosis of Chest Pain |Favorite Table|Download (.pdf) TABLE 7-1 Differential Diagnosis of Chest Pain
|Diagnostic Categories ||Diagnostic Considerations |
|Cardiac || |
Myocardial infarction or ischemia
|Pulmonary || |
Pneumonia ± pleural effusion
|Gastrointestinal || |
Esophageal foreign body
|Musculoskeletal || |
Slipping rib syndrome
Precordial catch syndrome (Texidor’s twinge)
|Psychogenic || |
|Idiopathic ||No organic or psychological cause identified |
A cardiac cause for pediatric chest pain is found in 0.6% to 5% of cases presenting to the ED.1,3,5 Myocardial infarction is rare in children, but has been reported in the literature in previously healthy adolescents.6 These patients usually present with the classic severe, substernal chest pain with radiation to the ...