Chest pain in children
Even though chest pain in children is a common symptom, unlike in adults it is seldom due to heart disease. Most often the cause of chest pain in children is not a major life threatening disease. Still chest pain can cause restriction of activities, absence from school and cause of anxiety to children and their parents. A good history and physical examination gives a lot of information to exclude any potentially serious condition causing chest pain, though it is rare. Costochondritis or inflammation of the joint between the breastbone and the ribs is a common cause of chest pain adolescent and preadolescent girls. It can be caused by viral illness or due to frequent coughing due to respiratory illness. It can be identified by localised tenderness at costochondral joint, the joint between the breastbone and the ribs. Injury to muscles and bones of the chest can be a cause of chest pain in children, but this cause is usually obvious from the history. But this can also occur following the lifting of heavy objects, frequent coughing or a lot of aerobic exercise. Stress or anxiety is also a common cause of chest pain though it may be difficult to elucidate because the cause of stress may not be obvious. Exam related stress and other usual causes of stress have to be thought of. Stress can also cause worsening of chest pain due to another cause. Hence other causes have to be excluded before attributing a sole etiological role for stress. Pleurisy or inflammation of the covering of the lung is another important cause of chest pain which characteristically increases on breathing in and has a catching nature. Sometimes chest pain can occur due to collection air (pneumothorax) or fluid in the pleural cavity surrounding the lungs. But in this case shortness of breath is usually a prominent associated symptom. Reflux esophagitis or inflammation of food pipe due to reflux of acid from the stomach can also cause chest paint. This causes a burning type of chest pain felt in the center of the chest.
Chest pain in children due to heart disease
Though rare, some cardiac causes of chest pain in children are worth noting. Pericarditis or inflammation of the covering of the heart can cause chest pain in children. Most cases of pericarditis are self limited, but can rarely become a serious problem. It causes a sharp pain which may be relieved by sitting and leaning forwards. Fever may be associated with pericarditis. Abnormalities of the coronary arteries which supply oxygenated blood to the heart can occur as a congenital anomaly or secondary to conditions like Kawasaki disease. Thickening of heart muscles due to heritable conditions like hypertrophic cardiomyopathy have also to be thought of. Mitral valve prolapse of bending backwards of the mitral valve between the left atrium (upper chamber) and the left ventricle (lower muscular chamber) can also cause chest pain, more often in adolescent females. Most often it is only a minor abnormality though rarely it can cause a leakage of the valve which can be significant. Another rare cause of chest pain could be an aneurysm of aorta (swelling of the great vessel which arise from the left ventricle). This is quite rare in children and can occur due to a condition known as Marfan syndrome. Rarely fast heart rate due to abnormal heart rhythms may also be felt as a chest discomfort by some children.