Milmedika

When a child complains of chest pain, the first question that arises is:

Should we be worried about a heart attack or a serious heart condition?

Fortunately, the answer is usually no. In fact, chest pain in children is rarely heart-related.

What are the most common causes of chest pain in children?

Various organs and systems can be the source of pain, including:

• Musculoskeletal system (the most common cause)
• Respiratory system
• Digestive system

In many cases, the exact cause cannot be determined.

What should you do when your child complains of chest pain?

The first step is to visit a pediatrician, who will assess:

• The circumstances under which the pain occurred.
• The nature and description of the pain.
• Any accompanying symptoms.

If the pain occurs at rest, in a specific position, or with movement—and if the child can pinpoint the pain with a finger—it is most likely not heart-related.

Pain described as a "stabbing sensation" or one that intensifies with pressure is usually harmless.

When is further cardiology evaluation necessary?

A cardiology consultation is recommended if the pain:

• Feels like pressure, burning, or tearing.
• Occurs during physical exertion.
• Is accompanied by arrhythmia, dizziness, or fainting.

Details about previous illnesses, pain frequency, and factors that trigger or relieve the pain are also important.

How to recognize heart-related chest pain?

Heart-related chest pain has distinct characteristics that pediatricians rarely overlook. For example:

• Pericarditis (inflammation of the heart lining):Pain worsens when lying down.
• Pain improves when leaning forward.
• Often accompanied by signs of infection.

A thorough medical history and clinical examination are often enough to rule out a cardiac cause without further testing.

What examinations are needed?

The pediatrician will perform:

• A clinical examination of the heart, lungs, and abdomen.
• Vital sign checks (pulse, blood pressure, heart rhythm).

In most cases, complex tests are not necessary. However, if a heart-related cause is suspected, the following may be recommended:

• Electrocardiogram (EKG)
• Chest X-ray
• Laboratory tests

Advanced tests such as echocardiography, Holter monitoring, stress testing, MRI, or cardiac catheterization are rarely required.

What is the pediatrician’s role?

• Rule out serious heart conditions.
• Reassure and support the family that the pain is unlikely to be dangerous.
• Initiate symptomatic treatment if necessary, which may include:
• Antihistamines
• Proton pump inhibitors
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Conclusion

Chest pain in children is rarely heart-related. However, any pain should be taken seriously and discussed with a healthcare provider—especially if it occurs during physical activity or is accompanied by arrhythmia or fainting.

The pediatrician plays a crucial role in evaluating the situation, providing the right advice, and starting appropriate treatment when needed.

Author: Dr. Draško Nikčević, pediatric cardiologist