See also

Pneumonia

Pneumothorax 

ANZ guidance for assessment of possible vaccine-induced pericarditis/myocarditis in children and adolescents presenting to the ED

Background

The majority of children presenting with chest pain as a primary complaint do not have a cardiac or other serious underlying disorder.  The priorities of assessment are to firstly exclude these disorders or provide appropriate emergency treatment and to subsequently form a diagnosis and management plan for the remainder of cases.  Common causes of paediatric chest pain in patients without risk factors for serious disease include:

• Musculoskeletal strains
• Respiratory infections with or without cough
• Asthma exacerbations
• Upper GI or biliary disease
• Precordial "catch" - sudden short sharp pains experienced, often on left side of chest, usually in healthy teenagers and young adults. The origin of this pain is unknown.
• Anxiety, idiopathic - many children have no organic diagnosis made.

The presence of certain risk factors increases the probability of potentially serious causes.

Risk factors for serious or life threatening conditions

Assessment

The most important step in initial assessment is identifying signs of cardiorespiratory distress:

• Dyspnoea, tachypnoea, increased work of breathing
• Hypoxia
• Abnormal pulse or blood pressure
• Poor perfusion
• Distended neck veins, muffled heart sounds
• Depressed mental state

For further specific assessment of underlying cause see chest pain flowchart below. 

Key examination and basic investigation findings that may be identified in uncommon serious conditions are presented in the table below:

Management

• Trauma patients and those with signs of cardiorespiratory compromise should be resuscitated along general principles prior to considering more directed management (see resuscitation).
• The flowchart below provides a guide for further management including special investigations, consultation and referral.
• All patients with positive risk factors for serious conditions should be discussed with senior staff prior to final disposition.
• Despite the rarity of serious underlying conditions, many children and parents have significant anxiety surrounding possible cardiac disease.  Specific reassurance is an important part of management.

Paediatric chest pain

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