When a child reports chest pain, the parental instinct is often to fear the worst. However, the vast majority of chest pain complaints are not related to the heart and are usually harmless. These non-cardiac causes are common, accounting for up to 98% of cases seen in outpatient settings. Understanding the frequent, benign triggers can help parents respond appropriately. This article explores the common non-cardiac causes of pediatric chest discomfort and identifies the specific warning signs that necessitate urgent medical attention.
Pain From Muscles and Joints
The most frequent source of chest pain in young people originates in the musculoskeletal structures of the chest wall. These issues involve the bones, cartilage, and muscles that protect the internal organs. This type of pain is often localized and can be reliably reproduced by pressing on the affected area, which helps medical professionals distinguish it from internal organ pain.
Costochondritis is the most well-known cause of musculoskeletal chest pain, resulting from inflammation of the costochondral cartilage. This cartilage connects the ribs to the sternum, and the inflammation causes a sharp, stabbing pain localized directly over the junction. The discomfort worsens with movement, deep breathing, or direct pressure on the inflamed spots. It often follows an upper respiratory infection involving heavy coughing or a period of unusual physical strain.
A related phenomenon is Precordial Catch Syndrome (PCS), characterized by a sudden onset of sharp, intense pain. The pain is typically felt on the left side of the chest, often below the nipple, and lasts only a few seconds to a few minutes before disappearing completely. Episodes frequently occur when the child is at rest or during a sudden change in posture, such as slouching. The pain intensifies with inhalation, which often causes the child to take shallow breaths until the spasm resolves.
Muscle strain is another common culprit, especially in active children involved in sports or strenuous activities. The intercostal muscles between the ribs, or the larger pectoral muscles, can be strained from repetitive motions like throwing or lifting. Even prolonged, forceful coughing due to a respiratory illness can cause soreness in the chest wall muscles. This pain is usually a dull ache that is tender to the touch and worsens with specific movements of the torso or arms.
Common Respiratory and Digestive Triggers
Beyond the structural issues of the chest wall, pain can also originate from the systems responsible for breathing and digestion. The respiratory system can cause chest discomfort through inflammation or excessive physical strain related to breathing difficulties. For example, conditions that involve a persistent, deep cough, such as bronchitis or a severe cold, can lead to significant muscle soreness in the chest and upper abdomen.
Asthma exacerbations may manifest as a feeling of tightness or pressure, which some children describe as chest pain. This sensation is caused by the constriction and inflammation of the airways, forcing the child to use their chest muscles harder. If a lung infection like pneumonia is present, inflammation of the pleura—the lining around the lungs—can cause a sharp pain called pleurisy, which is particularly noticeable with deep breaths.
The digestive system is a frequent source of referred chest pain, most commonly through Gastroesophageal Reflux Disease (GERD). GERD occurs when stomach acid flows backward into the esophagus, irritating the lining and causing heartburn. Since the esophagus runs through the chest cavity, this burning discomfort is often mistaken for a heart issue.
Reflux pain may be worse after eating large meals or when the child lies down shortly after consuming food. Certain foods, like those high in acid or fat, can trigger symptoms by relaxing the lower esophageal sphincter, allowing stomach contents to travel back up. Distinguishing GERD often relies on the description of the pain as burning and its correlation with food intake and body position.
When Anxiety Causes Chest Discomfort
Emotional and psychological distress can also manifest as physical symptoms, with chest discomfort being a common presentation of anxiety and stress in children. This type of pain is real, even though it does not stem from a physical disease process in the heart or lungs. The body’s “fight-or-flight” response, triggered by anxiety, causes physiological changes that can mimic physical ailments.
During periods of high stress or a panic attack, a child may experience hyperventilation, which is rapid, shallow breathing. This alters the balance of gases in the blood, leading to lightheadedness and chest tightness or pain. Chronic anxiety also causes unconscious tension in the chest wall muscles, leading to spasms and soreness. The pain can be sharp, crushing, or a persistent dull ache. Recognizing this link is important for both diagnosis and treatment, which involves addressing the underlying emotional distress.
Urgent Warning Signs and Medical Advice
While the vast majority of pediatric chest pain is benign, it is important to recognize the warning signs that require immediate medical evaluation. The primary warning sign is chest pain that occurs during or immediately after physical exertion or exercise. Pain that begins only when the heart rate and blood pressure are elevated is the most concerning indicator for a possible cardiac issue.
Other symptoms that warrant an immediate trip to the emergency room include pain accompanied by shortness of breath, dizziness, or fainting. Pain that radiates to the left arm, neck, jaw, or back is concerning. Additionally, any chest pain that is severe, crushing, or pressure-like and does not resolve quickly should be evaluated promptly.
For chest pain accompanied by systemic symptoms like a high fever, productive cough, or signs of severe illness, a child should be seen quickly to rule out conditions like pneumonia or myocarditis. If the pain is mild, brief, and not associated with these concerning signs, contact the pediatrician for guidance. A medical professional is necessary to definitively determine the cause and provide reassurance or appropriate treatment.