When a child reports chest pain specifically when breathing in (inspiratory chest pain), parents often fear a cardiac issue. It is important to know that in this age group, chest pain is overwhelmingly benign, meaning it is not dangerous and is rarely related to the heart. Inspiratory chest pain is discomfort that increases when drawing a deep breath. Understanding the most likely causes can help parents approach the situation with accurate information.
Common Benign and Transient Causes
The most common cause of chest pain in children is Precordial Catch Syndrome (PCS), which is completely harmless. PCS manifests as a sudden, sharp, stabbing pain localized to a small area, typically on the left side of the chest near the nipple area. The pain often occurs when the child is at rest and is noticeably worsened by drawing a deep breath, leading the child to take shallow, rapid breaths. Episodes are short-lived, usually lasting only 30 seconds to three minutes, and resolve spontaneously without any intervention. Forcing a deep breath can sometimes cause a “pop” or “click” sensation, which immediately relieves the pain.
Another common cause is Costochondritis, which involves inflammation of the costal cartilage that connects the ribs to the breastbone (sternum). Unlike the fleeting nature of PCS, the pain from Costochondritis often lasts longer, sometimes for hours or days, and may be dull or achy. The pain is felt at the front of the chest and worsens with deep breaths, coughing, or movement of the upper body. A distinguishing feature is that the pain is reproducible; pressing firmly on the junction where the rib meets the sternum will elicit tenderness. This condition can be triggered by a recent respiratory infection involving forceful coughing or by physical strain. Both PCS and Costochondritis are considered musculoskeletal issues.
Underlying Physical Conditions Requiring Diagnosis
While the majority of inspiratory chest pain is benign, other physical conditions require a physician’s diagnosis and management. Respiratory conditions are a frequent source of discomfort, especially if the pain is associated with other symptoms. Children with asthma, for example, may describe breathing difficulty as chest tightness or pain, particularly when airways narrow during exercise or due to environmental triggers.
Pleurisy, an inflammation of the membranes (pleura) that line the chest cavity and cover the lungs, can cause sharp pain that intensifies with a deep breath. This occurs when the inflamed layers rub against each other. Pleurisy is often seen alongside conditions like pneumonia, where the infection causes irritation near the lung surface.
Gastroesophageal Reflux Disease (GERD) occurs when stomach acid backs up into the esophagus, causing a burning sensation (heartburn) that can be mistaken for chest pain. This discomfort is often located behind the breastbone and may worsen when the child lies down or shortly after eating a large meal. Since the esophagus and heart are in close proximity, the brain can misinterpret the acid irritation as originating from the chest.
Musculoskeletal issues, such as direct trauma or a significant muscle strain from a fall or strenuous activity, can also cause pain upon inspiration. Since the chest wall muscles and ligaments move constantly with every breath, a strain will make this movement painful until the tissue heals. These conditions require medical evaluation to confirm the diagnosis and initiate appropriate treatment.
Warning Signs That Require Immediate Attention
Serious causes of chest pain in children are rare, but certain accompanying symptoms require an immediate visit to the emergency room. These warning signs include:
- Pain that occurs exclusively or primarily during physical exertion, such as running or playing sports.
- Chest pain combined with a sudden loss of consciousness or fainting (syncope).
- Pain that radiates away from the chest to the jaw, neck, or down the arm.
- Significant difficulty breathing or noticeable shortness of breath.
- A rapid or pounding heart rate (palpitations) experienced concurrently with the pain.
- The child’s skin or lips appearing bluish (cyanosis), indicating poor oxygen saturation.
- Pain accompanied by a high fever, a widespread rash, or if the child appears pale and generally unwell.
- Chest pain that is crushing or squeezing in nature and persists continuously without relief.
How Doctors Investigate Chest Pain
The medical investigation begins with a detailed patient history, which is the most informative step in the diagnostic process. The doctor asks specific questions about the pain’s characteristics, including its location, duration, triggers, and factors that make it better or worse. Determining if the pain occurs at rest or with activity helps categorize the potential cause.
Following the history, a physical examination focuses on the heart, lungs, and chest wall. The physician listens carefully to heart and lung sounds, checking for murmurs, rubs, or abnormal breathing patterns. The chest wall is then examined by palpation, where the doctor presses on the ribs and sternum to see if the pain can be reproduced, which strongly suggests a musculoskeletal cause like Costochondritis.
If the history or physical exam raises concern for a cardiac or serious pulmonary condition, initial diagnostic tests may be ordered to rule out serious pathology. A non-invasive electrocardiogram (EKG) is often performed to record the heart’s electrical activity, checking for rhythm disturbances or structural signs of strain. A chest X-ray may also be used to visualize the lungs and bony structures, helping to identify conditions like pneumonia, a collapsed lung, or fractures.
These tests serve as a screening process, and in the overwhelming majority of cases, they come back completely normal, confirming the benign nature of the child’s chest pain. More complex imaging, such as an echocardiogram, is typically reserved for children whose symptoms include the warning signs or whose initial EKG is abnormal.