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Chest Pain

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Definition

  • Pain or discomfort in the chest (front or back)
  • The chest includes from the top to the bottom of the rib cage

Causes of Chest Pain

  • Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders.
  • Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome.
  • Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.
  • Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing.
  • Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone).
  • Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well.
  • Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture.
  • Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause.
  • Pleurisy (Serious). Pleurisy is another problem of pneumonia. If the infection involves the lung's surface, that area of the chest will hurt.

Pain Scale

  • Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: the pain is very bad. It keeps your child from doing all normal activities.
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When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out (fainted)
  • Bluish lips or face
  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Severe constant pain (child not able to move or do anything)

Call Doctor or Seek Care Now

  • Your child has heart disease
  • Trouble breathing, but not severe
  • Taking a deep breath makes the pain worse
  • Heart is beating very rapidly
  • After a direct blow to the chest
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Fever is present
  • Cause of chest pain is not clear. Exception: pain due to coughing, sore muscles, heartburn or other clear cause.
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Chest pains only occur with hard exercise (such as running)
  • Sore muscles last more than 7 days
  • Heartburn lasts more than 2 days on treatment
  • Chest pains are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Normal chest pain from sore muscles
  • Normal chest pain from heartburn
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Care Advice

Sore Muscle Pain Treatment

What You Should Know About Mild Chest Pain:

  • Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment.
  • Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event.
  • Here is some care advice that should help.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil).
  • Use as needed.
  • Continue this until 24 hours have passed without pain.

Cold Pack for Pain:

  • For the first 2 days, use a cold pack to help with the pain.
  • You can also use ice wrapped in a wet cloth.
  • Put it on the sore muscles for 20 minutes, then as needed.
  • Caution: avoid frostbite.

Use Heat After 48 Hours:

  • If pain lasts over 2 days, put heat on the sore muscle.
  • Use a heat pack, heating pad or warm wet washcloth.
  • Do this for 10 minutes, then as needed.
  • Reason: increase blood flow and improve healing.
  • Caution: avoid burns.
  • A hot shower may also help.

Stretching the Muscles:

  • Gentle stretching of the shoulders and chest wall may help.
  • Do sets of 10 twice daily.
  • This may prevent muscle cramps from coming back.
  • Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain.

What to Expect:

  • For sore muscles, the pain most often peaks on day 2.
  • It can last up to 6 or 7 days.

Call Your Doctor If:

  • Pain becomes severe
  • Pain lasts over 7 days on treatment
  • You think your child needs to be seen
  • Your child becomes worse

Heartburn (Reflux) Pain Treatment

What You Should Know About Heartburn:

  • Heartburn is common.
  • It's due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach.
  • Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching.
  • Here is some care advice that should help.

Antacids:

  • Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed.
  • Dose: give 1 to 2 tablespoons (15 - 30 mL).
  • If you don't have an antacid, use 2 to 3 ounces (60 - 90 mL) of milk.
  • For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days.

Heartburn Prevention:

  • Do not eat too much at meals. This overfills the stomach.
  • Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine.
  • Do not bend over during the 3 hours after meals.
  • Do not wear tight clothing or belts around the waist.

What to Expect:

  • Most often, heartburn goes away with treatment.
  • But, heartburn also tends to come back. So, preventive measures are important.

Call Your Doctor If:

  • Heartburn doesn't go away after 2 days of treatment
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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