From the Guidelines
The most common etiologies of chest pain in pediatric patients are musculoskeletal causes, including costochondritis, muscle strain, and potential consequences of recent or occult chest trauma. According to the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1, the differential diagnosis for noncardiac causes of acute chest pain is quite broad and includes respiratory, musculoskeletal, gastrointestinal, psychological, and other causes.
Some of the key points to consider when evaluating chest pain in pediatric patients include:
- Musculoskeletal causes are the most common, including costochondritis, muscle strain, and potential consequences of recent or occult chest trauma such as rib fracture 1
- Gastrointestinal causes, commonly esophageal, can present with chest pain, including gastrointestinal reflux and esophageal dysmotility as well as gastritis from either medications or peptic ulcer disease 1
- Respiratory causes are less frequent but potentially more serious and include PE, pneumonia, and pneumothorax, with many patients experiencing dyspnea in addition to chest pain 1
- Psychological causes are usually diagnoses of exclusion but merit consideration in the right context 1
When evaluating a child with chest pain, it's essential to consider the pain characteristics, associated symptoms, and triggering factors, and to be aware of red flags that warrant immediate medical attention. Musculoskeletal causes, such as costochondritis and muscle strain, should be considered first, as they are the most common etiologies of chest pain in pediatric patients, as stated in the 2021 guideline 1.
From the Research
Etiologies of Chest Pain in Pediatric Patients
The most common causes of chest pain in pediatric patients include:
- Idiopathic chest pain, which accounts for 21-59% of cases 2, 3
- Musculoskeletal disorders, ranging from 6.7% to 37.1% of cases 3, 4, 5
- Pulmonary disorders, such as pneumonia and pneumothorax, accounting for 12-24.3% of cases 2, 3
- Psychologic disorders, accounting for 17-19% of cases 2
- Gastrointestinal disorders, such as gastroesophageal reflux disease, accounting for 5-7% of cases 2, 3
- Cardiac disorders, which are rare, accounting for 0.3-4% of cases 2, 3, 5
Diagnostic Approach
A careful physical examination can reveal important clues and save unnecessary investigations 2, 3, 6. The use of diagnostic tests such as electrocardiogram, chest X-ray, and echocardiogram may be necessary in some cases 3, 5. However, the routine use of echocardiogram in the evaluation of children with chest pain may not be necessary 5.
Management
Treatment of chest pain in pediatric patients depends on the underlying cause 2, 3. Reassurance and supportive care may be offered to patients with benign causes of chest pain 6. Specific treatment may be commenced when an organic cause is found, such as the use of inhaled bronchodilators for suspected exercise-induced asthma or anti-reflux medication for gastroesophageal reflux disease 2.