Chest pain in children (non-cardiac)

Chest pain is very common in children and teenagers, but for most children, the pain is not related to the heart and is not life-threatening. Less than 2% of children who present to an emergency department or a GP for chest pain, actually have a heart issue.  You can usually treat chest pain in children with pain relief.

The most common causes of chest pain are musculoskeletal (bone, cartilage, muscles, tendons, or ligaments) and pulmonary (relating to the lungs). For example, excessive coughing during a respiratory illness (cold or flu) can lead to strain or overuse of the muscles in the chest.

What causes non-cardiac chest pain?

The most common cause is inflammation or swelling of cartilage. The costal cartilage connects the ribs to the sternum. They can become inflamed after muscle strain or trauma.

It can also be related to respiratory illnesses which have caused lots of coughing, or due to gastrointestinal issues, or can be anxiety related e.g., panic attacks.

Common non-cardiac causes

Musculoskeletal

• Idiopathic
• Muscle strain
• Costochondritis
• Slipped rib
• Chest wall abnormalities
• Trauma
• Precordial catch syndrome

Pulmonary

• Pneumonia
• Pleuritis
• Pneumothorax
• Asthma
• Pulmonary embolus
• Pulmonary contusion
• Pleural effusion

Gastrointestinal

• Gastroesophageal reflux disease
• Peptic ulcer disease
• Gastritis
• Oesophageal spasm
• Oesophagitis

Psychogenic

• Anxiety
• Depression
• Bullying

Miscellaneous

• Herpes zoster
• Toxin/drug exposure
• Breast tenderness

Signs and symptoms

Common signs and symptoms of non-cardiac chest pain include:

• sharp pains that come and go
• pain that occurs when resting or occurs in multiple locations across chest
• pain when breathing in
• areas on the chest that are tender to touch.

Diagnosis

A child may be referred to a paediatric cardiologist for tests to rule out any issues with the heart. These tests may include:

• Electrocardiogram (ECG) to measure the electrical activity of the heart.
• Echocardiogram (Echo) uses sound waves to produce a picture of the heart, to rule out undiagnosed heart defects.
• Exercise stress test (EST) on a treadmill or bicycle, during which the patient’s heart rhythm and blood pressure are monitored. This is sometimes arranged for pain associated with exercise.
• Use of a portable monitor (for 24 hours or several days) to record heart rate variations and rhythm. This is sometimes arranged for pain associated with palpitations.

Treatment

Treatment for non-cardiac chest pain will depend on the underlying cause of the pain. Pain can sometimes take weeks or months to resolve, and can affect quality of life if not managed appropriately.

You can help your child manage the pain by:

• Using pain relief such as  paracetamol (Panadol) or ibuprofen (Nurofen).
• Reassuring them the pain is not related to their heart and will improve.
• Using anxiety-reduction techniques.
• Talk to your local GP about a pain management plan if the pain is ongoing.

When to seek help

Call Triple Zero (000) and ask for an ambulance if your child complains of severe chest pain or collapses, or has chest pain and also:

• a very fast heart rate
• is short of breath
• feels faint or dizzy
• has a fever higher than 38.5°Cwith no clear cause

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

If your child’s chest pain is mild and your child is otherwise feeling well, your child doesn’t need to see a doctor. But you should monitor them and see your GP if the chest pain doesn’t go away with simple pain relief or it gets worse.

Developed by Queensland Paediatric Cardiology Service, Queensland Children's Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS242. Reviewed: October 2023.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.