Objectives: To evaluate causes of chest pain in children referred to pediatric cardiology clinic and the need for echocardiography in these patient. METHODS: A prospective study conducted in Prince Ali Hospital, in the southern of Jordan, between Nov. 2010 till Nov. 2012. Clinical history and physical examination done. Electrocardiogram, chest X-ray, and echocardiogram for all patients, and a 24-hour Holter monitoring, if needed. RESULTS: A total of 145 children were referred to pediatric cardiology clinic. Musculoskeletal causes were the most common accounting for (36.6%), idiopathic chest pain (31%), respiratory causes (15%), gastrointestinal causes (4.1%) and miscellaneous disorders (6.9%), while cardiac causes found in 9 patients (6.2%), echocardiography was positive in 4 patients (2.8%). CONCLUSIONS: The study reveals that cardiac etiologies for childhood chest pain account for a small percentage, and these can be excluded by a complete history and physical examination. Therefore, echocardiogram may not be necessary, and shouldn't be part of routine evaluation of children with chest pain.