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Weekly, we see so many children arrive at the pediatric emergency room with chest pain. The parents, and often the children, are worried that their child has heart disease. For adults, especially middle-aged and older, that may be the case. Chest pain = seek medical care for heart disease. For children however, often everything is completely different.
The chest is more than just the heart
“Chest pain” in children usually means pain in the upper half of the body. From the head down. There are, besides the heart, lungs, 24 ribs, pleura and pericardium. In addition, a celestial mass of muscles and nerves on the back and between the ribs, arms, shoulders, joints and vertebrae. Any of these can cause pain.
In fact, in children, muscles and ribs hurt much much much more often than the heart.
Sometimes children find it difficult to distinguish pain in the stomach from in the chest.
Pain in one spot = not dangerous!
If you ask your child where their pain is and they point to a specific spot on the chest, then it is not the heart that hurts. The heart hurts in a much larger and more diffuse area.
If it is sore when you press the point, it may be the muscles or bones. Tell the child that it is completely harmless and will go away. Gladly ‘blow away’ the pain.
Sore in some movements, not in others = not the heart
If the child has pain while bending forward or backwards, or not bending at all, then it is not the heart that is causing the pain. That is not how the heart behaves. Just like when the child has pain in a sore spot, it is probably the muscles or bones that hurt. Tell the child it’s not the least bit dangerous. ‘Blow away’ the pain and begin reading a book, or continue with what you were doing.
Chest pain and breathless
If the child has chest pain and is suddenly out of breath, seek the pediatric emergency room. It can (but does not have to) be a hole in the pleura that can sometimes occur without us knowing why. Air enters the pleura and it often needs to be emptied in hospital.
Diffuse chest pain
If the child has diffuse or radiating, excruciating pain in the chest most of the day, it may in rare cases, be the heart. Children don’t have heart attacks. (The exceptions are: children with a hereditary disorder where you start developing high cholesterol known as homozygous familial hypercholesterolemia; or children with vascular inflammations of the heart’s blood vessels – very rare). However, children may get an infection-inflammation of the heart which present as soreness in the chest.
Sometimes (but not always), this inflammation has been preceded by a cold or other infection. This is especially risky in teenages who do heavy training in the cold. A training ban should be implemented as soon as they have a sore throat or fever!
A child who has excruciating pain in the chest most of the time, and seems obviously affected by the pain, needs to be examined at the pediatric emergency room. With the help of a medical examination and possibly ECG and blood tests, it is possible to ascertain whether or not it is the heart that is affected.
But you took the ECG of my baby when she had a sore chest!
We often take an ECG on children who have been admitted into the emergency room with chest pain. This is because it is routine in adults. We do this in order to care for those with heart attacks as quickly as possible. But as I mentioned earlier, often everything is different in children. It’s a bit dramatic to automatically take an ECG on children, because it sends the wrong message. It says, “best go to the hospital when your child’s chest hurts, so we are certain that it’s not the heart”. But we know that in children, it’s generally not the heart.
The good news is that the vast majority of times your child has chest pain, you do not need to visit any kind of medical care!