Chest pain in a child is one of the most frightening symptoms a parent can encounter. Your mind might immediately jump to serious heart problems common in adults, but the reality for children is very different. The good news is that in the vast majority of cases, chest pain in children and teenagers is not related to the heart.
This guide is designed to help parents understand the common causes of chest pain in children, recognize the rare warning signs of a heart issue, and know when to seek medical care.
In this article, you will learn:
- Why most childhood chest pain is not a heart problem
- The most common non-heart-related causes
- The rare “red flag” symptoms that could point to a heart issue
- When to call your doctor versus when to go to the emergency room
- How doctors determine the cause of the pain
Common Non-Heart Causes of Chest Pain (The Usual Suspects)
Most of the time, chest pain in children originates from the muscles, bones, lungs, or digestive system—not the heart itself.
Musculoskeletal Pain (The 1 Cause): This is the most frequent reason for chest pain in kids and is often called “chest wall pain.”
- Costochondritis: This is an inflammation of the cartilage that connects the ribs to the breastbone (sternum). It can feel like a sharp, tender pain that gets worse with a deep breath or when you press on the area. It’s often caused by a minor injury, heavy coughing, or even lifting something heavy. Think of it as a “sprain” in the chest wall.
- Muscle Strain: A pulled or strained muscle in the chest from sports, coughing, or exercise can cause a sore, aching pain.
Respiratory Issues
Problems with the lungs and airways are another common source of pain.
- Severe Coughing: A persistent cough from a cold, bronchitis, or pneumonia can make the chest muscles very sore.
- Asthma: Children with asthma, especially during a flare-up, can feel tightness and pain in their chest due to the effort of breathing.
Digestive Problems
The esophagus (the tube that carries food to the stomach) runs through the chest, so stomach issues can feel like chest pain.
- Acid Reflux (GERD): Stomach acid splashing up into the esophagus can cause a burning sensation often described as heartburn. This pain can be worse after meals or when lying down.
- Swallowing Problems: Swallowing a large pill or a big piece of food can sometimes cause temporary pain in the chest.
Anxiety and Stress
Emotional factors are a very real cause of physical symptoms. A child experiencing stress at school or home may complain of chest pain, a rapid heartbeat, and shortness of breath, which are physical manifestations of anxiety.
When Could Chest Pain Be Heart-Related? (The Rare Red Flags)
While rare, it’s important to know the warning signs that chest pain might be linked to a heart condition. Unlike the typical chest wall pain, heart-related pain in children is more likely to have these features:
- Occurs during physical exertion: The pain consistently appears when your child is running or playing hard and goes away with rest.
- Accompanied by other symptoms: The chest pain happens along with fainting (syncope), dizziness, a racing heartbeat (palpitations), or extreme shortness of breath.
- Described as pressure or tightness, rather than a sharp, localized pain.
- There is a family history of sudden death in a young relative or known genetic heart conditions.
- The child has a known heart condition from birth (a congenital heart defect).
If the chest pain fits any of these descriptions, it requires prompt medical evaluation.
When to Seek Medical Care
Knowing who to call and when is crucial.
Call Your Doctor for an Appointment If:
- The pain is mild but keeps coming back.
- You can reproduce the pain by pressing on a specific spot on the chest (this strongly suggests a musculoskeletal cause).
- The pain seems linked to eating or is accompanied by a sour taste in the mouth (suggests reflux).
- You suspect the pain might be related to stress or anxiety.
Seek Emergency Care Immediately If Your Child Has Chest Pain AND:
- Faints or loses consciousness.
- Has severe trouble breathing.
- Has a very rapid or irregular heartbeat.
- Looks pale or has a bluish tint to their lips or skin.
- The pain is severe, crushing, and does not go away.
How Doctors Diagnose the Cause of Chest Pain
A doctor will start with a thorough investigation to rule out serious causes.
- Medical History: The doctor will ask detailed questions: When did the pain start? What does it feel like? What makes it better or worse? Has the child been sick recently?
- Physical Exam: The doctor will listen carefully to the heart and lungs, press on different parts of the chest to check for tenderness (a key sign of musculoskeletal pain), and check vital signs.
- Further Tests (If Needed): If the history and exam suggest a possible heart or lung issue, tests may be ordered:
- Electrocardiogram (ECG): A painless test that checks the heart’s electrical rhythm.
- Chest X-ray: To look at the heart and lungs.
- Echocardiogram: An ultrasound of the heart to see its structure and function.
For the vast majority of children, a detailed history and physical exam are all that’s needed to diagnose the cause.