Should Your Child See a Doctor?

Chest Pain

Definition

  • Pain or discomfort in the chest (front or back)
  • This includes the area from the lower neck to the bottom of the rib cage

Causes  

  • Most persistent chest pain is from a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.
  • Occasionally, chest pain follows strenuous exercise (e.g., throwing a baseball), lifting (e.g., weights or heavy boxes), or work that involves the upper body (e.g., digging). This type of muscle soreness often increases with movement of the shoulders.
  • Heartburn is due to reflux of stomach contents. It usually causes a burning discomfort under the lower sternum (breastbone).
  • Most brief chest pain lasting minutes is from harmless muscle cramps or a pinched nerve.
  • Heart disease is hardly ever the cause of chest pain in children.

When to Call Your Doctor for Chest Pain

Call 911 If…

 
  • Your child has severe difficulty breathing (struggling for each breath, grunting to push air out, unable to speak or cry or lips are bluish)
  • Your child is not moving or too weak to stand
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Your child has heart disease
  • Difficulty breathing, but not severe
  • Taking a deep breath makes pain worse
  • Severe chest pain
  • Heart beating very rapidly or has fainted
  • Followed a direct blow to the chest
  • Unexplained chest pain present (EXCEPTION: pain due to coughing, sore muscles, heartburn or other obvious cause)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Fever is present
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Chest pains only occur with vigorous exercise (eg, running)
  • Sore muscles lasts over 7 days
  • Heartburn persists over 2 days on treatment
  • Chest pains are a recurrent chronic problem
 

Parent Care at Home If

  • Normal chest pain from sore muscles or heartburn and you don't think your child needs to be seen
 

Home Care Advice for Chest Pain

Treatment for Sore Muscle Pain

  1. Reassurance:
    • Chest pains in children lasting for a few minutes are usually harmless muscle cramps. They need no treatment.
    • Chest pains (sore muscles) from vigorous exercise or work using the upper body usually start soon after the activity and need the following treatment.
     
  2. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen. Continue this until 24 hours have passed without pain.
  3. Local Heat: Apply local heat for 20 minutes 4 times a day. Use a heating pad, warm washcloth or hot shower to the area.
  4. Stretching Exercises: Gentle stretching exercises of the shoulders and chest wall in sets of 10 twice daily may prevent recurrence of muscle cramps. Stretching exercises can be continued even during active chest pain. Avoid any that increase the pain.
  5. Expected Course: For sore muscles, the pain usually peaks on day 2 and lasts 6 or 7 days.
  6. Call Your Doctor If:
    • Pain becomes severe
    • Pain lasts over 7 days on treatment
    • Your child becomes worse
     

Treatment for Heartburn (Reflux) Pain

  1. Reassurance:
    • Heartburn is common
    • It's due to stomach acid refluxed up into the esophagus
    • Causes a burning discomfort behind the lower sternum, a sour (acid) taste in the mouth and belching
     
  2. Antacids:
    • Heartburn is usually easily relieved by 1 to 2 tablespoons (15 - 30 ml) of liquid antacid by mouth.
    • If you don't have an antacid, wash out the esophagus with 2 to 3 ounces (60 - 90 ml) of milk.
    • For persistent heartburn, give antacid 1 hour before meals and at bedtime for a few days.
     
  3. Heartburn Prevention:
    • Avoid overeating which overfills the stomach
    • Avoid foods that increase reflux (chocolate, fatty foods, spicy foods, carbonated soda, caffeine)
    • Avoid bending over during the 3 hours after meals
    • Avoid tight clothing or belts around the waist
     
  4. Call Your Doctor If:
    • Heartburn doesn't resolve after 2 days of treatment
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. Brown RT. Recurrent chest pain in adolescents. Pediatr Ann. 1991;20:194-199.
  2. Brown RT. Costochondritis in adolescents. J Adolesc Health Care. 1981;1:198-201.
  3. Evans DA and Wilmott RW. Pulmonary embolism in children. Pediatr Clin North Am. 1994;41:569.
  4. Galioto F. Child chest pain. Contemp Pediatr. 2007; 24(5):47-57.
  5. Palmer KM, Selbst SM, Shaffer S, et al. Pediatric chest pain induced by tetracycline ingestion. Pediatr Emerg Care. 1999;15:200-201.
  6. Reynolds JL. Precordial catch syndrome in children. South Med J. 1989;82:1228-1230.
  7. Selbst SM. Chest pain in children. Pediatr Rev. 1997;18:169-173.
  8. Wiens L, Sabath R, Ewing L, et al. Chest pain in otherwise healthy children and adolescents is frequently caused by exercise-induced asthma. Pediatrics. 1992;90:350-353.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/13/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.