Sudden Chest Pain in Children: Causes and Concerns

Q: Sudden Chest Pain in Children: Causes and Concerns

Hello： Sometimes, growing adolescents may experience neuralgia that causes chest pain. <br>However, if you are concerned, it is advisable to visit a hospital for a check-up (consult a pediatric cardiologist; if unavailable, see an adult cardiologist).

Sudden chest pain?

Hello Doctor: My child, who is in first grade, suddenly experienced chest pain during class, describing it as radiating to his back and more intense than the three episodes he had last year.
His father took him to a general pediatric clinic, where the doctor suggested it might be neuralgia.
However, when he was born and ready for discharge, the obstetrician recommended that we take him to a larger hospital for a cardiac evaluation.
Due to postpartum recovery in the countryside and subsequent years of routine pediatric visits for colds, no further cardiac evaluations were suggested by the pediatricians.
It wasn't until four or five years later, during a visit to the obstetrician for a second pregnancy, that the doctor casually inquired if we had taken the child for a cardiac check-up, which reminded me of the previous recommendation.
After discussing it with his father, he felt that if there were any issues, the pediatrician would have detected them during auscultation, so there shouldn't be a problem.
However, yesterday he experienced pain again, more intense than last year, feeling as if someone was squeezing his heart, but it lasted only a few seconds.
I would like to know if this is truly just neuralgia.
I recall that last year the pain also occurred in winter, and yesterday was quite cold as well.
Could this be related to the weather? Both episodes occurred while he was at rest (sitting) and not during any physical activity.
Each time he complains of chest pain, it causes me great concern.
I want to understand whether this is neuralgia or if there might be an underlying cardiac issue.
He has had one episode this year and three episodes last year, which all occurred around the same month, although I can't remember which month it was.

Ms. Chen, 40~49 year old female. Ask Date: 2009/12/18

Dr. Bu Shiyun reply Cardiology

Hello: Sometimes, growing adolescents may experience neuralgia that causes chest pain.
However, if you are concerned, it is advisable to visit a hospital for a check-up (consult a pediatric cardiologist; if unavailable, see an adult cardiologist).

Reply Date: 2009/12/18

More Info

Understanding sudden chest pain in children can be a source of significant concern for parents. It is essential to approach this issue with a comprehensive understanding of potential causes and the appropriate steps to take for diagnosis and treatment.

Firstly, it is important to recognize that chest pain in children can arise from various sources, including musculoskeletal issues, gastrointestinal problems, respiratory conditions, and, less commonly, cardiac concerns. In your child's case, the description of the pain being sudden and sharp, particularly if it radiates to the back, could suggest a few possibilities.

1. Musculoskeletal Pain: This is one of the most common causes of chest pain in children. It can result from muscle strain, costochondritis (inflammation of the cartilage connecting the ribs to the sternum), or even postural issues. Given that your child experiences pain while sitting still, this could be a plausible explanation, especially if there is no associated shortness of breath or other systemic symptoms.

2. Nerve Pain: As mentioned by the pediatrician, nerve pain (neuropathic pain) can also manifest as sharp, sudden pain in the chest area. This type of pain can be triggered by various factors, including stress or anxiety, which can be more pronounced in children during school hours.

3. Gastrointestinal Issues: Conditions such as gastroesophageal reflux disease (GERD) can cause chest pain that may mimic cardiac pain. If your child has any accompanying symptoms such as heartburn or stomach discomfort, this could be a contributing factor.

4. Cardiac Concerns: While less common, it is crucial to rule out any cardiac issues, especially given your child's history and the recommendation for further evaluation. Symptoms that might raise concern for cardiac problems include persistent pain, pain associated with exertion, or any accompanying symptoms such as palpitations, dizziness, or fainting.

Given that your child has experienced this pain multiple times, it would be prudent to seek a thorough evaluation from a pediatric cardiologist. They can perform a detailed assessment, which may include an electrocardiogram (ECG), echocardiogram, or even a Holter monitor to assess heart rhythm over time.
Additionally, considering the timing of the pain (occurring during colder weather and while at rest), it may be beneficial to monitor any potential triggers or patterns associated with the episodes. Keeping a diary of when the pain occurs, its duration, intensity, and any accompanying symptoms can provide valuable information for healthcare providers.

In conclusion, while the pain could be attributed to non-cardiac causes such as musculoskeletal or nerve pain, it is essential to ensure that no underlying cardiac issues are present. A thorough evaluation by a specialist will help clarify the situation and provide peace of mind for you and your child. Remember, it is always better to err on the side of caution when it comes to health concerns in children.

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