Chest pain in children

Differential diagnosis

Chest pain in children is usually evaluated in the emergency departments. It can be distressing for parents and children. Pediatric chest pain differs from chest pain in adults because it is most often unrelated to the heart. The causes of pediatric chest pain vary according to the organ or tissue in the child. that generates the pain. Generally, muscular skeletal pain, which includes costochondritis, is the reason for the emergency department visit. Pain that is felt in the chest but is due to muscular skeletal inflammation or an unknown cause and accounts for 7% and 69% visits. Muscular skeletal pain is described and defined differently as a diagnosis of exclusion or is documented as being associated with idiopathic causes. Asthma and other respiratory symptoms are the second most common presentation. Respiratory associated causes compose 13% to 24% of pediatric chest pain symptoms. Gastrointestinal and psychogenic symptoms reported by parents and patients occur less than 10% of the time. Cardiac causes of pediatric chest pain are found infrequently and are not identified more than 5% of the time. Unknown causes, were estimated to account for 20% to 61% of the final diagnosis given. Patients who receive a diagnosis of cardiac disease are more apt to have acute pain. This pain often awakes them from sleep or presents with fever or abnormal observations found during the physical examination. Trauma can also be a cause for chest pain and has been found to be associated with the pain in 5% of the patients.

Children can present with chest pain can have a sudden onset related to vigorous physical activity and coughing. These symptoms seem to be closely associated with asthma. Infection with Haemophilus influenzae can cause chest pain.

Preliminary

Since most causes of pediatric and adolescent chest pain are not considered life-threatening, parents and their children are often reassured that in the majority of cases, the cause of the pain can be determined. If the child or adolescent appears to have some dehydration, and intravenous line along with administration of saline is done. The clinician may or may not decide to perform diagnostic testing . This is especially true if the child or adolescent has symptoms of chronic pain. If an obvious cause of the chest pain is not readily apparent, testing may begin with an x-ray and an electrocardiogram . This helps the clinician to determine whether or not the cause of pain is related to pulmonary or cardiac causes.

Some preliminary diagnosis include:

• bruising and chest pain could be from unrecognized trauma
• an abnormal abdominal examination may be related to a possible gastrointestinal condition with pain referred to the chest.
• abnormal blood pressure measurements suggests to the clinician that dehydration may be present and related to cardiac insufficiency
• heart sounds such as heart murmur, rub, arrhythmia may indicate to a condition of the heart
• the pain may be related to a chronic illness and may be part of a serious condition such as systemic lupus erythematosus or Hodgkin lymphoma
• pleural effusion and chest pain may be related to arthritis
• decreased breath sounds or wheezing can be suggestive of asthma or the fatigue of chest wall muscles
• subcutaneous emphysema can be felt by the clinician indicating a pneumomediastinum or pneumothorax
• tenderness of the costochondral junctions or the wall of the chest is suggestive of musculoskeletal or costochondritis pain