Chest pain in children: diagnosis through history and physical examination

Abstract

ABSTRACT Introduction: Chest pain is a common complaint in the pediatric age group and can be a physically and emotionally distressing symptom. Although chest pain in children rarely indicates serious cardiac problems, chest pain is perceived as “heart pain” to most children and their families and presents a diagnostic challenge to health care providers. Methods: A prospective study was conducted to identify specific factors in history taking and physical examination that permit accurate diagnosis of the cause of pediatric chest pain. Fifty children (ages 5–21 years; mean, 13 years), referred to the cardiology clinic with the chief complaint of chest pain, underwent systematic history taking, physical examination, and electrocardiogram testing. Results: The following diagnoses were made: 38 children (76%) had musculoskeletal/costochondral chest pain, 6 children (12%) had exercise-induced asthma, 4 children (8%) had chest pain resulting from gastrointestinal causes, and 2 children (4%) had chest pain resulting from psychogenic causes. Discussion: All the children in this study had noncardiac causes of their chest pain. This finding supports previous research suggesting that chest pain in children is rarely of cardiac origin. This article reviews the causes of pediatric chest pain and suggests an approach to its evaluation and management. J Pediatr Health Care. (2000). 14, 3–8.