Patient Information

Chest Pain in Children and Adolescents

Chest pain is very common in children and teenagers and, happily, is only rarely associated with heart problems. Children frequently have pain because of muscle strain or injury or, very commonly, spasm in the muscles of the chest. This sort of chest pain usually feels sharp or jabbing, lasts less than a minute, and can occur during exercise or at rest. Chest pain from muscle spasm often is made worse by taking a deep breath, moving a particular way or pressing on the area. It is not associated with difficulty breathing, dizziness, fainting, or a feeling of a racing heartbeat. Some people, particularly young women, can develop inflammation in the joints that connect the ribs to the sides of the breast bone (costochondritis), causing pain in this area. Other types of non-cardiac chest pain include "growing pains", a dull aching pain localized around the center of the chest. Eating too quickly, or eating cold food or food that can get stuck in the esophagus (tube connecting the mouth to the stomach) can cause esophageal spasm, a squeezing pain in the center of the chest that is made worse by swallowing. Heartburn, caused by stomach contents washing up the esophagus can also feel like pain in the chest, particularly to children. Also, problems with the lungs and windpipe can cause chest pain. Infections of the lining of the lungs can cause fever and pain with breathing (pleurisy). Smoking or infections can cause coughing and pain in the windpipe (trachiitis). Children with asthma or other lung problems seem to have more problems with chest wall muscle spasm, and can also have other chest pains of a more vague nature.

Chest pain associated with exercise merits special evaluation to rule out medical problems such as coronary artery problems, abnormal heart rhythms or inflammation of the heart.  Still, chest pain with exercise most often represent chest wall muscle spasm, heart burn (reflux), exercise-induced asthma or overexertion. Often young women may experience improvement in chest pain of this sort by switching to a very supportive well-fitting sports bra, ideally one featuring underwire support, wide adjustable straps and an adjustable back (one resource in this regard can be found at www.x-chrom.com/braguide.php4). My female colleagues recommend the Champion Action Shape and Champion Double Dry Body Bra.

Chest pain due to overexertion may be caused by fatigue and ischemia of the respiratory muscles in the chest wall as a sign of overexertion. While not a dangerous condition, this sort of symptom should reasonably be considered a sign that one has reached one's physical limit.

Only a small percentage of children with chest pain turn out to have a serious problem, but warning signs that should prompt immediate evaluation by a physician include chest pain associated with any of the below:

For more information about chest pain on the web, have a look around some these sites:

Cincinnati Children's Hospital: Chest Pain

Pennsylvania Children's Hospital: Chest Pain

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