My child has a pain in their chest

Chest pain in children is very common, most often innocent and not cardiac in origin.
The chest is large area composed of many parts and organ systems. The chest is covered in skin; there are lots of ribs, each with their own nerves and blood supply; muscles in-between the ribs; a breast bone, 2 big lungs and a heart in-between. Our brains are hard-wired to think that any discomfort in the 'Chest' is arising from the heart.

Musculo-skeletal pain (pain arising from the ribs or chest muscles) is the most common cause of chest pain or chest discomfort in children and teenagers. This type of pain often has no clear precipitant and usually reflects 'growing pains' associated with growth and a change in chest shape. Musculoskeletal type pain is often sharp or 'plueritic'. This type of pain is often made worse by breathing in and out or pressing the area reported. Cardiac pain is usually different in character. It is often a dull or heavy ache that is precipated during or after exercise.

Should I be worried?

True cardiac chest pain is rare in a teenager or child. A detailed clinical history of the nature, type and frequency of the pain can often help a padiatric cardiologist stratify whether the pain has an underlying cardiac cause. A 12 lead ECG (or electrocardiogram) is a valuable initial investiugation. This test involves placing 12 stickers or electrodes on the chest and analysing how the electrical impulses spread through the heart. The presence of other symptoms such as palpitations (an irregualr or fast heart rate) or a history of syncope or collapse would prompt more detailed investiagation and assessment. A positive family history of cardiac problems or history of early / unexplained death would raise caution.

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What investigations are needed?

Further investigations above an ECG often include an echocardiogram to look more closely at the heart muscle and structure of the heart. If there is a history of palpitation or suspicion of an abnormal heart rhythm a 24 Hr holter cardiac minitor may be fitted to look at the heart rate and rhythm over a longer period. If there are exercise associated symptoms, a treadmill or bike exercise test may be undertaken, with real-time ECG monitoring to assess the heart under physical stress.

The results of these tests usually confirm cardaic normality and often provide both the child and their families with valuable reassurance.