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What causes chest pain in children and adolescents?


Chest pain is a common symptom in children and adolescents and causes a great deal of anxiety in patients and parents. Most children between ages 5 and 18 years report chest pain at least once. They are rarely suggestive of a sinister cause and these can be easily ruled out after consulting Dr Khambadkone.


Chest pain can be from cardiac or non-cardiac causes. Non cardiac causes are most likely from chest wall structures (bones, joints, cartilages, muscles between the ribs) and are called musculoskeletal pains. These generally are described as sharp or stabbing and could occur for a few seconds to minutes multiple times and often come during rest or simple activities. The pain worsens with deep breathing, coughing, laughing or unusual postures and can get worse by pressing upon those points on  the chest. The pain responds well to common pain-killers such as paracetamol or anti-inflammatory medications like Ibuprofen.


Other causes could be related to lungs during infection with severe chesty cough (viral bronchitis or pneumonia or pleurisy). Gastro oesophageal reflux (heart burn) is common in adolescents and associated with stress and anxiety.


Cardiac chest pains could be related to infection of heart muscle or covering of the heart (myocarditis or pericarditis). This is often preceded by fever, malaise, fatigue, loss of appetite following a tummy bug (vomiting or diarrhoea). Rarely, this can worsen rapidly needing emergency care and could cause a heart attack. Other causes of cardiac chest pain are from congenital abnormalities of coronary arteries (blood vessels supplying the heart muscle with oxygen). Although rare, they can cause sudden collapse during or soon after strenuous exertion related to exercise or sports. Severe heart muscle thickness from severe heart valve disease such as aortic valve stenosis or heart muscle disease such as hypertrophic cardiomyopathy can present with chest pain from insufficient blood and oxygen supply to thickened muscle. Any chest pain associated with exercise, palpitations or fainting (syncope) is likely to suggest an underlying cardiac cause and needs to be investigated urgently.




What tests are done to investigate chest pain?

A good history, physical examination and baseline investigations such as ECG and Echocardiography are often enough to rule out any serious underlying problem. Exercise testing is important in certain conditions to assess symptoms in more detail. In some conditions, more advanced imaging such as Coronary CT angiography or Magnetic Resonance Imaging (MRI) may be necessary. In most cases, if the initial tests are not suggestive of cardiac chest pain, children and parents will be strongly reassured by Dr Khambadkone and do not always require follow up.

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