Back to Basics: Pediatric Chest Pain

Pediatric Chest Pain:


  • Mostly no identifable cause vs. muscle pain vs. GI
  • Mostly Non-Cardiac


Differential Diagnosis:

  • Cardiac à HOCM v. prolonged QTc v. WPW v. anomalous coronary artery v. SVT v. perimyocarditis
  • Pulmonary à pneumothorax v. pneumomediastinum v. pneumonia v. asthma v. aspirated foreign body v. PE (rarely)
  • GI à reflux, foreign body
  • Chest wall à trauma, costochondritis.
  • Heme à sickle cell crisis, acute chest syndrome

Use HPI and Phycial exam to guide need for EKG, CXR, Labs

  •  May not need any diagnostics!

Red flags = palpitations, syncope, exertional, abnormal exam/ vitals, family history of sudden death at a young age, Kawaski’s history


Selbst SM1. Approach to the child with chest pain. Pediatr Clin North Am. 2010 Dec;57(6):1221-34