Differential Diagnosis for Pediatric Chest Pain

Single Most Likely Diagnosis

• Musculoskeletal Chest Pain: This is the most common cause of chest pain in children, often related to overuse or strain of the chest muscles or inflammation of the cartilage and bones in the chest wall (costochondritis).

Other Likely Diagnoses

• Asthma or Reactive Airway Disease: Chest pain can be a symptom of asthma or reactive airway disease, especially if the pain is worsened by respiratory symptoms such as wheezing or coughing.
• Gastroesophageal Reflux Disease (GERD): GERD can cause chest pain in children, often described as a burning sensation that worsens with eating or lying down.
• Precordial Catch Syndrome: A benign condition characterized by sharp, stabbing chest pain that can be quite frightening but is not associated with any serious underlying condition.

Do Not Miss Diagnoses

• Myocarditis or Pericarditis: Inflammation of the heart muscle or the sac surrounding the heart can cause chest pain and is potentially life-threatening.
• Pulmonary Embolism: Although rare in children, a pulmonary embolism can cause sudden, severe chest pain and is a medical emergency.
• Pneumonia or Pneumothorax: Infections or air leaks in the lung can cause chest pain and are critical to diagnose and treat promptly.

Rare Diagnoses

• Hypertrophic Cardiomyopathy: A rare heart condition that can cause chest pain, especially with exertion, and is a significant cause of sudden cardiac death in young athletes.
• Marfan Syndrome: A genetic disorder that affects the body's connective tissue and can lead to problems with the heart, including chest pain.
• Sickle Cell Disease: Chest pain can be a symptom of sickle cell crisis, where abnormal red blood cells cause episodes of pain due to vaso-occlusion.