Many children come to the ER every week with chest pain. The parents, and often the children, are worried that the child has a heart disease. For adults, especially middle-aged and older people, this is the case. Chest pain = seek medical attention for heart disease. For children, everything, as is often the case, is completely different.
The chest does not just consist of the heart
"Chest pain" usually means pain in the upper half of the body below the head. In addition to the heart, there are lungs, 24 ribs, lung sac and heart sac. In addition, a whole lot of muscles and nerves on the back and between the ribs, arms, shoulders, joints and spine. All this can hurt.
In fact, muscles and ribs hurt much more often than the hearts of children.
Sometimes it can be difficult to distinguish whether it hurts the stomach or there is pain in the chest.
Pain at one location = not dangerous!
If you ask your child where she or he is in pain and the child points at a point somewhere on the chest, it is not the heart that hurts. The heart hurts in a much larger and more diffused area.
If it is sore when you press the point, it is with certainty that it is the muscles or skeleton that have been affected by some small ailment that causes pain. Tell the child that it is completely harmless and will go away, happily dismiss the fear.
Pain in some areas, not in others = not the heart
If the child has a central pain, or a back pain, or straight forward pain then it is not the heart that hurts. This is not how the heart behaves. Just as when the child is in pain at a specific point, it is in all probability muscle or skeleton that hurts. Tell the child that it is not the least bit dangerous, dismiss the fear and start reading a book, or continue with what you are doing.
Chest pain and shortness of breath
If the child has a chest pain and suddenly becomes short of breath, come to the ER. There may (but need not) be a hole in the lung sac that can sometimes occur without us knowing why. Then air enters the lung sac and it often needs to be discharged at hospital.
Deep chest pain
If the child has diffused, pressing pain in the chest most of the day, it is rarely the heart that hurts. Children do not have a heart attack. (The exception is children with hereditary extremely high blood fats, so-called homocygous familial hypercholesterolemia, or children with vascular inflammation in the blood vessels of the heart - very rare). On the other hand, children may have an infection-inflammation of the heart whose first symptoms may be just chest pain.
Sometimes (but not always) this inflammation has been preceded by a cold or other infection. Particularly risky is the hard workout of a cold-suffering teenager (a ban on exercise due to sore throat or fever!).
So a child who suffers from severe chest pain most of the time and appears to be obviously affected by the pain needs to be examined at the pediatric emergency room. With the help of medical examination and possibly ECG and blood tests it is possible to determine whether the heart is affected or not.
But you took ECG on my baby when she had a pain in the chest!
It is normal to do an ECG on children who come in with chest pain to the emergency room. This is because it is routine to take ECG on adults who come in with chest pain, to be able to treat them for myocardial infarction as quickly as possible. It can be a bit of a shame when it happens automatically to children as soon as they enter the door, as the signal being sent becomes "best to go to hospital when it hurts in their chest, so we are sure it is not the heart".
This is not the case, the good news is that most of the times your child has a chest pain, you do not need to visit any health care!