Chest pain in children

Jason E. Lang, Andrew Colin

Research output: Contribution to journalArticle

Abstract

Pain arising from the chest area creates anxiety in children and their parents, often leading to unnecessary activity restriction, school absences, and medical utilization. A thorough but pragmatic evaluation requires a grasp of the pathophysiology of several organ systems and an understanding of epidemiologic and behavioral patterns specific to children. Few symptoms in pediatrics test a clinician's skill more than chest pain. Though the etiology is frequently benign, it is often uncertain, and sprinkled among cases of chest pain are potentially fatal conditions. This review summarizes chest pain in children of all ages, with particular emphasis on adolescents. We review the organic causes including musculoskeletal trauma, strain and inflammation, respiratory conditions such as occult asthma, pneumonia and bronchitis, and the important role of esophageal disease. We discuss the relatively minor role of cardiac disease, but highlight the conditions that are vital to consider, such as arrhythmia, mitral valve disease, Kawasaki syndrome, Marfan syndrome, and cocaine use. Anxiety, depression, and other psychological factors often further complicate the presentation. A pediatrician's best tools are diagnostic acumen, which may be lifesaving, and supportive dialogue, to impart reassurance to a worried family. We explore the most common and most lethal causes by age, organ system, and predisposing illness. We review the neuroanatomic considerations important in visceral, chest wall, and mediastinal pain, and the sensation within the lung, airways, and pleurae. Lastly, we highlight pragmatic 'take-home' tips for the clinician, most of which involve good history-taking and physical examination, but also include the utility of basic testing that can detect the rare cases of fatal cardiopulmonary disease.

Original languageEnglish
Pages (from-to)245-258
Number of pages14
JournalCurrent Pediatric Reviews
Volume2
Issue number3
DOIs
StatePublished - Aug 1 2006
Externally publishedYes

Fingerprint

Chest Pain
Anxiety
Esophageal Diseases
Marfan Syndrome
Mucocutaneous Lymph Node Syndrome
Pleura
Bronchitis
Thoracic Wall
Hand Strength
Medical Schools
Mitral Valve
Cocaine
Physical Examination
Cardiac Arrhythmias
Heart Diseases
Pneumonia
Asthma
Parents
History
Depression

Keywords

  • Adolescents
  • Angina
  • Asthma
  • Chest pain
  • Musculoskeletal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Chest pain in children. / Lang, Jason E.; Colin, Andrew.

In: Current Pediatric Reviews, Vol. 2, No. 3, 01.08.2006, p. 245-258.

Research output: Contribution to journalArticle

Lang, JE & Colin, A 2006, 'Chest pain in children', Current Pediatric Reviews, vol. 2, no. 3, pp. 245-258. https://doi.org/10.2174/157339606778019710
Lang, Jason E. ; Colin, Andrew. / Chest pain in children. In: Current Pediatric Reviews. 2006 ; Vol. 2, No. 3. pp. 245-258.
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