Chest pain in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords: Chest pain in kids
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Common causes of chest pain in children include:
| Causes of pediatric chest pain |
| Musculoskeletal |
| Respiratory |
|
| Psychogenic |
|
| Gastrointestinal |
| Cardiac |
|
| Miscellaneous |
|
| Idiopathic |
Epidemiology and Demographics
Natural History, Complications and Prognosis
Diagnosis
Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography or Ultrasound
CT scan
MRI
Other Diagnostic Studies
Holter monitoring to diagnose arrhythmia as a cause of intermittent chest pain.
Treatment
Medical Therapy
The management depends on the clinical status and stability of the patient, patients with severe respiratory distress, hemodynamic instability require rapid care of the (ABC) airway, breathing, and circulation according to the Pediatric Advanced Life Support (PALS).
The medical management of stable patients differs according to the cause:
- Costochondritis and ms strain can be treated with NSAIDs and muscle relaxants.
- Infections like pneumonia can be treated with antibiotics, supplemental oxygen, and mechanical ventilation as needed
- Gastritis and esophagitis can be treated with H2 blockers and PPIs.
- Acute chest syndrome in sickle cell disease managed with pain control, antibiotics, hydration and blood transfusion, or exchange transfusion.
- Pulmonary embolism requires anticoagulant therapy or, thrombolytics in hemodynamically unstable children.
- Ischemia and myocardial infarction should receive anticoagulation, pain management, and catheterization.
- Heart failure should be managed with diuretics, ACEIs, and beta-blocker if no contrindication.
- Tachyarrhythmias should be managed according to Pediatric Advanced Life Support (PALS).
- Pericarditis with pericardial effusion requires pericardiocentesis in patients with tamponade.
- Tumors require further workup and the management differs according to the type of the tumor.
Surgery
- Aortic root dissection managed with requires emergent surgical intervention.
- Tension pneumothorax requires a needle or chest tube thoracostomy.
- Airway foreign body with obstruction requires emergent securing of the airway and bronchoscopy.
- Esophageal foreign body: management depends on the type of body. sharp foreign bodies, impacted batteries, or magnets require urgent removal.
References
- Yeh TK, Yeh J.Chest Pain in Pediatrics. Pediatr Ann. 2015; 44:274.
- Ji Hye Chun, et al.Analysis of clinical characteristics and causes of chest pain in children and adolescents. Korean J Pediatr. 2015; 58: 440.
- Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013; 163:896.
- Selbst SM. Approach to the child with chest pain. Pediatr Clin North Am. 2010; 57:1221