Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Nontraumatic chest pain in children and adolescents: Approach and initial management

Robert L Geggel, MD
Erin E Endom, MD
Section Editors
David R Fulton, MD
Gregory Redding, MD
Jan E Drutz, MD
Gary R Fleisher, MD
Deputy Editor
James F Wiley, II, MD, MPH


Nontraumatic chest pain is a common symptom in children and adolescents and is a frequent complaint in patients seeking primary, emergent, or subspecialty care [1-4]. Although the etiology is benign in most cases, this symptom may lead to school absences, restriction of activities and causes considerable anxiety in patients and their families. A thorough history and physical examination usually can determine the cause and identify patients who require acute intervention and those who can be managed with reassurance and continued follow-up. Laboratory testing is necessary only in a small number of patients [5]. In the absence of associated symptoms of illness, positive findings on physical examination related to the cardiac or respiratory systems, or symptoms during exertion, a serious organic cause is unlikely.

This topic will discuss the approach to nontraumatic chest pain in children and adolescents. The causes of nontraumatic chest pain in children and adolescents, pediatric thoracic trauma, and the emergent evaluation of respiratory distress in children and adolescents, with or without chest pain, is discussed separately:

(See "Causes of nontraumatic chest pain in children and adolescents".)

(See "Overview of intrathoracic injuries in children".)

(See "Initial evaluation and stabilization of children with thoracic trauma".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 22, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Selbst SM, Ruddy RM, Clark BJ, et al. Pediatric chest pain: a prospective study. Pediatrics 1988; 82:319.
  2. Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics 1976; 57:648.
  3. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr 2013; 163:896.
  4. Danduran MJ, Earing MG, Sheridan DC, et al. Chest pain: characteristics of children/adolescents. Pediatr Cardiol 2008; 29:775.
  5. Selbst SM. Chest pain in children. Pediatrics 1985; 75:1068.
  6. Selbst SM. Approach to the child with chest pain. Pediatr Clin North Am 2010; 57:1221.
  7. Massin MM, Bourguignont A, Coremans C, et al. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila) 2004; 43:231.
  8. Collins SA, Griksaitis MJ, Legg JP. 15-minute consultation: a structured approach to the assessment of chest pain in a child. Arch Dis Child Educ Pract Ed 2014; 99:122.
  9. Porter GE. Slipping rib syndrome: an infrequently recognized entity in children: a report of three cases and review of the literature. Pediatrics 1985; 76:810.
  10. Coleman WL. Recurrent chest pain in children. Pediatr Clin North Am 1984; 31:1007.
  11. Evans DA, Wilmott RW. Pulmonary embolism in children. Pediatr Clin North Am 1994; 41:569.
  12. Asnes RS, Santulli R, Bemporad JR. Psychogenic chest pain in children. Clin Pediatr (Phila) 1981; 20:788.
  13. Kashani JH, Lababidi Z, Jones RS. Depression in children and adolescents with cardiovascular symptomatology: the significance of chest pain. J Am Acad Child Psychiatry 1982; 21:187.
  14. Pantell RH, Goodman BW Jr. Adolescent chest pain: a prospective study. Pediatrics 1983; 71:881.
  15. Nakao K, Ohgushi M, Yoshimura M, et al. Hyperventilation as a specific test for diagnosis of coronary artery spasm. Am J Cardiol 1997; 80:545.
  16. Kane DA, Fulton DR, Saleeb S, et al. Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis 2010; 5:366.
  17. Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics 2011; 128:e1062.
  18. Friedman KG, Kane DA, Rathod RH, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics 2011; 128:239.
  19. Glassman MS, Medow MS, Berezin S, Newman LJ. Spectrum of esophageal disorders in children with chest pain. Dig Dis Sci 1992; 37:663.
  20. Selbst SM, Ruddy R, Clark BJ. Chest pain in children. Follow-up of patients previously reported. Clin Pediatr (Phila) 1990; 29:374.
  21. Rowland TW, Richards MM. The natural history of idiopathic chest pain in children. A follow-up study. Clin Pediatr (Phila) 1986; 25:612.
Topic Outline