The management and referral of undifferentiated chest pain in childhood
Chest pain in children is usually due to either a viral infection or musculoskeletal pain, often associated with a history of (sometimes very minor) trauma or coryzal symptoms.
Musculoskeletal (including Costochondritis)2 account for >50% of presentations.
Cardiac causes account for ≤1% of children with chest pain2.
Occurs at any age but more commonly in children whom can communicate themselves.
In adolescents, consider causes such as drug use or alcohol related gastritis / vomiting.
Referral to secondary care:
- Chest pain associated with syncope or exertional syncope
- Chest pain associated with major trauma that has not already been evaluated
- Chest pain in children with known cardiovascular disease or cardiac abnormality
- Children with other medical condition that increases cardiac risks, or which need further evaluation and treatment for non cardiac pain (malignancy, hypercoagulability, hyperviscosity syndromes, severe anaemia eg thalassaemia or sickle cell)
- Pain associated with foreign body ingestion
Children that do not require assessment at children’s emergency department
- Well with chest pain relieved by inhaler use and known asthma
- Chest pain worse on palpation with either a history of minor trauma or concomitant viral infection
- Short lasting chest pain not present on assessment with no other concerning features
- Sternal border pain with a significant coughing history or multiple recent vomiting episodes
- Muscular chest pain that started the day after new exercise / weight lifting
- If likely to be traumatic or inflammatory – simple analgesia including NSAIDS is appropriate, with reassurance and advice on likely duration of symptoms.
- If pain associated with asthma – consider further evaluation of inhaler technique and overall asthma management (including parental smoking cessation advice if appropriate)
Guidelines and links