Assessing chest pain in children

Abstract

In adults chest pain, whilst sometimes benign, can be the symptom of serious cardiac pathologies. However, in children with chest pain, serious organic pathologies are rare. Nonetheless, this symptom still causes considerable anxiety in parents, children themselves and often their doctors. The assessment of chest pain in children should aim to identify or exclude factors or red flags suggestive of serious organic causes. With a good history and thorough examination most children do not need further investigation and can be discharged with reassurance (Figure 1). This article discusses how to assess for red flags and considers two ‘typical’ cases that might be referred to a general paediatrician for further assessment (Box 1). Box 1Two ‘typical’ referrals with chest pain Case 1 A 10-year-old boy presents to GP with chest pain for 6 months. His mother is very concerned. Of note a 15 yr old boy at this child's school collapsed and died recently following a boxing match; on examination his GP finds a soft systolic murmur. Case 2 A 16-year-old girl presents to the emergency department with severe chest pain and breathlessness of sudden onset; her height is 180 cm and she has no significant past medical history. Her dad died at 37 years old and post-mortem confirmed dissection of the aorta. A 10-year-old boy presents to GP with chest pain for 6 months. His mother is very concerned. Of note a 15 yr old boy at this child's school collapsed and died recently following a boxing match; on examination his GP finds a soft systolic murmur. A 16-year-old girl presents to the emergency department with severe chest pain and breathlessness of sudden onset; her height is 180 cm and she has no significant past medical history. Her dad died at 37 years old and post-mortem confirmed dissection of the aorta.