When a child complains that their chest hurts, parents often link the symptom to serious cardiac issues. However, chest pain is a common complaint in children and adolescents, and it is rarely a sign of a heart problem, with only about 1% to 4% of cases having a cardiac origin. Over 95% of pediatric chest pain stems from less serious causes, most often involving the chest wall, lungs, or digestive system. Identifying the characteristics of the pain is the first step toward understanding its source and determining whether medical attention is necessary. This information is intended to help parents recognize common, non-urgent causes while highlighting the few warning signs that require immediate intervention.
Most Frequent Non-Urgent Causes
The most common causes of chest pain in children are musculoskeletal, originating from the muscles, bones, or cartilage of the chest wall. Costochondritis is a frequent diagnosis, involving inflammation of the cartilage connecting the ribs to the breastbone (costosternal joints). This condition often causes a sharp, stabbing pain localized to a small area, frequently on the left side. It can be triggered by a recent viral illness or repetitive physical strain. A defining characteristic is that the pain is reproducible: it worsens when pressure is applied directly to the affected joint area.
Another common musculoskeletal cause is precordial catch syndrome, sometimes called a stitch in the side, characterized by sudden, sharp pain. This pain is usually felt just under the left breastbone, lasts for only a few seconds or minutes, and is often aggravated by taking a deep breath. Although the exact cause is not fully known, it is thought to be related to a pinched nerve or muscle spasm in the chest wall, and it resolves spontaneously. Active children may also experience general muscle strain from sports, heavy lifting, or physical activity, leading to soreness and tenderness in the chest wall muscles.
Psychogenic factors, such as anxiety, stress, and panic attacks, frequently manifest as chest discomfort in children and adolescents. Emotional distress can trigger the body’s “fight or flight” response, causing physical symptoms like muscle tension and shallow breathing. The child perceives this as chest pain or tightness. The pain may be described as pressure, tightness, or a burning sensation, and can occur intermittently or continuously. In many cases, a specific stressful event or underlying anxiety disorder can be identified.
Causes Related to the Respiratory and Digestive Systems
Pain originating from the respiratory system is often linked to the act of breathing or underlying lung conditions. Respiratory infections, such as pneumonia, can cause irritation of the pleura, resulting in a sharp pain called pleurisy. This pain is worsened by deep inhalation or coughing. Asthma, a common chronic respiratory condition, can also present as chest tightness or discomfort, which the child may interpret as pain, especially during an exacerbation or following exercise.
Persistent and forceful coughing, often associated with a cold, flu, or asthma, can strain the intercostal muscles between the ribs, leading to chest wall soreness. Although this is musculoskeletal pain, the root cause is the respiratory illness and resulting muscle overuse. This soreness is typically diffuse and not localized to a single joint, which differentiates it from costochondritis. The pain generally improves as the underlying cough subsides.
The digestive system is another source of non-cardiac chest pain, primarily through gastroesophageal reflux disease (GERD) or acid reflux. When stomach acid backs up into the esophagus, it causes a burning sensation described as heartburn, which is felt behind the breastbone. This pain is often triggered by eating, especially spicy or acidic foods, and can be worse when the child is lying down or at night. In rare cases, inflammation of the esophagus (esophagitis) can result from chronic reflux and cause similar, but more persistent, pain.
Warning Signs and When to Seek Emergency Care
Although serious causes are rare, certain “red flag” symptoms associated with chest pain warrant immediate medical evaluation. Chest pain that occurs exclusively during physical exertion, such as running or playing sports, is a primary warning sign that requires urgent attention. This type of activity-related pain can suggest rare cardiac issues, such as an abnormal coronary artery structure or hypertrophic cardiomyopathy.
Other symptoms that should prompt an immediate visit to the emergency department include chest pain accompanied by fainting or near-fainting episodes (syncope). Chest pain accompanied by difficulty breathing, a very fast or irregular heartbeat (palpitations), or dizziness also requires immediate attention. Pain that radiates to the arm, neck, or jaw, which is a common presentation in adult heart conditions, is another serious symptom in children.
A child presenting with chest pain alongside signs of systemic illness, such as a high fever, extreme paleness, or excessive sweating, should also be seen immediately. These symptoms can point toward severe infections, such as myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the sac surrounding the heart). Recognizing the combination of chest pain and these systemic symptoms is the basis for seeking emergent care. Parents should also share any family history of sudden cardiac death or congenital heart defects with medical providers during the evaluation.