Chest Pain in Children and Teenagers

Chest pain in children: Red Flags, and When to See a Specialist

Few things alarm a parent more than a child complaining that their chest hurts. The immediate fear (that something is wrong with the heart) is entirely understandable. Adults associate chest pain with heart attacks, and that association is hard to set aside when it is your child reporting the symptom.

The reassuring reality is this: chest pain in children and teenagers is common, and the heart is the cause of a small proportion of cases. The overwhelming majority of childhood chest pain has a benign, non-cardiac explanation. A small number of cases do reflect something important, and knowing how to tell them apart is exactly what this page sets out to help with.

Dr. Alessandro Giardini has written this guide to give parents a clear, honest, and practical understanding of chest pain in children: what causes it, what the red flags are, when investigation is needed, and when a specialist review is the right step.

How Common Is Chest Pain in Children?

Chest pain is one of the most frequent reasons children and teenagers visit a paediatric cardiologist. Research from major paediatric centres suggests that the peak age is between 10 and 21 years, with most episodes being brief, self-limiting, and benign.

Understanding the real landscape of paediatric chest pain helps enormously. The most common causes are musculoskeletal (up to 70 per cent of cases), followed by gastrointestinal, respiratory, psychogenic, and idiopathic causes. Cardiac causes, though rare, are the ones that require identification.

What Causes Chest Pain in Children?

Musculoskeletal Causes: The Most Common by Far

The chest wall (the ribs, breastbone, cartilage, and surrounding muscles) is the most frequent source of chest pain in children. This type of pain has nothing to do with the heart and carries no serious implications.

Costochondritis is the most commonly identified musculoskeletal cause. It is an inflammation of the cartilage connecting the ribs to the breastbone (sternum), producing tenderness that parents and children can often reproduce by pressing on the affected area. Costochondritis is particularly common in adolescent girls and often follows a viral illness or persistent coughing. Episodes can last several weeks and usually respond well to ibuprofen.

Precordial catch syndrome produces sharp, localised pain along the lower left side of the chest that comes on suddenly, lasts only seconds to a few minutes, and then disappears. Almost all episodes occur on the left side, typically at rest or with mild activity, and breathing in deeply makes the pain worse. Some young people find that a forced deep breath resolves it with a sensation of something “popping.” The cause remains uncertain but likely involves a pinched intercostal nerve or muscle spasm. Precordial catch syndrome is entirely benign, requires no treatment, and tends to resolve as adolescence progresses.

Muscle strain from sport, heavy lifting, or vigorous exercise causes chest wall pain that feels worse with movement or on pressing the area. In teenagers who train intensively, chest wall strain is a common and self-limiting problem.

Chest wall injury from direct trauma during sport or physical activity is straightforward to identify from the history. Rest and pain relief address it effectively.

Gastrointestinal Causes

Acid reflux and gastro-oesophageal reflux disease (GORD) are frequently underrecognised as causes of chest pain in children. The burning, central chest discomfort that characterises reflux can be difficult for younger children to describe accurately, and they may report it simply as “chest pain.” The pain typically follows meals, worsens on lying down, and often comes with a sour taste or burping. Effective treatments exist and the condition carries no serious risk.

Oesophageal spasm, gastritis, and, in rare cases, foreign body ingestion can also produce chest pain of gastrointestinal origin. A history of pain related to swallowing, eating, or specific foods usually points the assessment in the right direction.

Respiratory Causes

Asthma is a common cause of chest tightness in children, particularly during or after exercise. Wheeze or shortness of breath often accompanies the tightness, and there is frequently a background history of asthma or atopy. Exercise-induced bronchospasm can occur even in children not previously diagnosed with asthma.

Pneumonia and other respiratory infections produce pleuritic chest pain, typically a sharp, stabbing discomfort that worsens with breathing in. Fever, cough, and generally feeling unwell usually accompany this type of pain.

Spontaneous pneumothorax, though uncommon, tends to occur in tall, thin adolescent boys and causes sudden, severe chest pain with breathlessness. This requires urgent medical attention.

Psychological and Stress-Related Causes

Anxiety is a genuine and common cause of chest pain in young people, and one that deserves acknowledgment rather than dismissal. Emotional stress, school pressures, relationship difficulties, and anxiety disorders can all produce real, physical chest pain. In one study, researchers identified anxiety disorder in 60 per cent of children presenting with non-cardiac chest pain.

The pain associated with anxiety is typically dull, variable in location, and tends to worsen at times of stress. This pain is not a sign of weakness and not imaginary. The origin is psychological, but the pain itself is entirely real. Addressing the underlying anxiety, through psychological support and appropriate school engagement, can make a significant difference.

Having chest pain, particularly repeated episodes, can itself become a source of anxiety. Some children restrict their activity and miss school out of fear that their chest pain reflects something serious. Clear explanation and reassurance from a specialist can break this cycle effectively.

Cardiac Causes: Rare, but Important to Identify

Although cardiac causes account for only a small minority of chest pain in children, they are the most important to identify and the ones that most concern families. The following conditions can produce cardiac chest pain in childhood and adolescence:

Pericarditis is inflammation of the sac surrounding the heart. It produces a sharp, central chest pain that typically worsens on lying flat and improves when sitting forward. Pericarditis often follows a viral illness and is usually self-limiting, though it requires medical assessment and monitoring.

Myocarditis is inflammation of the heart muscle itself. Viral infections, including COVID-19, can trigger it, and it has also been documented as a rare complication of mRNA vaccination in adolescent males (though rates are low and the condition almost always resolves without lasting effects). Children with myocarditis typically report chest pain, palpitations, shortness of breath, and fatigue. An ECG and cardiac MRI are the key investigations.

Hypertrophic cardiomyopathy (HCM) is a genetic condition causing abnormal thickening of the heart muscle. It affects approximately one in 200 people and is the leading cause of sudden cardiac death in young athletes. Chest pain in HCM typically occurs during exertion and may be accompanied by dizziness or pre-syncope. Dr. Giardini’s specialist work in hypertrophic cardiomyopathy means that families with this diagnosis can access highly focused expertise at Great Ormond Street Hospital and across his private clinics in London.

Arrhythmias such as supraventricular tachycardia (SVT) cause chest discomfort, palpitations, and a racing heartbeat. Episodes tend to come and go, often starting and stopping abruptly.

Anomalous coronary arteries are a congenital variant in which a coronary artery originates from an abnormal position. This is the second most common cause of sudden cardiac death in young athletes and can produce exertional chest pain.

Aortic stenosis due to a bicuspid or otherwise abnormal aortic valve can cause exertional chest pain in children with significant valve narrowing. A heart murmur is usually detectable on examination.

Kawasaki disease, when inadequately treated in infancy, can cause coronary artery aneurysms that lead to ischaemic chest pain later in childhood or adolescence.

What Are the Red Flags for Cardiac Chest Pain?

The following features should always prompt urgent or early specialist assessment. They do not guarantee a cardiac diagnosis, but they significantly raise the index of suspicion and require investigation.

Chest pain that occurs during exercise (rather than after it) is the most important red flag. Pain that develops while a child is actively running, cycling, or playing sport warrants urgent assessment. Chest pain accompanied by fainting or near-fainting is equally concerning. Pain associated with palpitations, a racing heartbeat, or an irregular pulse requires prompt evaluation. Chest pain that radiates to the jaw, neck, arm, or back should be taken seriously. A family history of sudden cardiac death in a young relative (under 40), or a known familial cardiac condition such as HCM or Long QT Syndrome, significantly raises the importance of thorough assessment. Any child with a known congenital heart condition who develops chest pain needs a cardiology review without delay.

If your child develops chest pain with any of these features, call 999 or go directly to the nearest emergency department.

When Should I See a Paediatric Cardiologist?

Not every episode of chest pain requires specialist cardiology assessment, but the following situations do warrant one:

Chest pain that occurs during exercise. Any episode associated with fainting, palpitations, or breathlessness. Chest pain that is recurrent or has continued for more than a few weeks without a clear explanation. A family history of sudden cardiac death, arrhythmia, or inherited cardiac conditions. A known cardiac condition in the child. A GP or paediatrician who has found a murmur or an abnormal ECG.

Even without red flags, parents who feel concerned and seek expert reassurance have every reason to request a specialist assessment. Many families who see Dr. Giardini in his private clinics are doing precisely this: seeking a clear, expert explanation.

Dr. Giardini sees children and teenagers with chest pain at several London locations. His approach starts with a detailed clinical history: spending time understanding exactly when the pain occurs, what brings it on, and what the child’s cardiac and family background looks like, because this careful history is often more informative than any single investigation.

How Is Chest Pain in Children Investigated?

The Clinical History

A thorough history is the most powerful diagnostic tool in paediatric chest pain assessment. The timing, location, quality, and duration of the pain, its relationship to exercise and meals, associated symptoms, and the family history all point towards or away from a cardiac cause. Children who describe brief, sharp, left-sided pain at rest that resolves on its own are often experiencing precordial catch syndrome. Children who describe chest pain coming on during running, with dizziness alongside it, need a very different assessment.

Electrocardiogram (ECG)

A resting ECG is quick, painless, and provides important information about the heart’s rhythm and electrical activity. Abnormalities on the ECG raise concern for arrhythmia, pericarditis, myocarditis, or ion channel conditions such as Long QT Syndrome. A normal ECG is helpful but does not by itself exclude all cardiac causes.

Echocardiogram

An echocardiogram (heart ultrasound) gives detailed images of the heart’s structure and function. Cardiologists use it as the key investigation for identifying hypertrophic cardiomyopathy, aortic stenosis, pericardial effusion, and structural abnormalities of the coronary arteries. The scan is painless and involves no radiation.

Ambulatory Heart Rhythm Monitoring

When a clinician suspects arrhythmia, a Holter monitor or longer-term event recorder captures the heart’s rhythm over 24 to 48 hours or longer. This is particularly useful when symptoms occur intermittently and a resting ECG has not caught them.

Exercise Testing

An exercise test can provoke symptoms under controlled conditions, helping to determine whether chest pain has an exertional component and whether any rhythm or ECG changes occur during physical activity. Dr. Giardini’s clinical background in exercise physiology in children with heart and lung conditions makes this assessment particularly well-suited to his practice.

Cardiac MRI

Cardiac MRI gives detailed assessment of the heart muscle and proves particularly useful when a clinician suspects myocarditis or cardiomyopathy. It provides information that echocardiography alone cannot deliver.

What Are the Treatment Options?

Treatment depends entirely on the underlying cause. For musculoskeletal pain, reassurance, ibuprofen, and time are almost always sufficient. Dietary modification and medication resolve acid reflux effectively. Appropriate inhaler therapy addresses asthma-related chest pain.

For cardiac causes, management is condition-specific. Clinicians treat pericarditis with anti-inflammatory medication and rest. Arrhythmias often respond to medication, and catheter ablation is an option for recurrent or troublesome episodes. Specialist teams manage HCM through a programme of monitoring, medication, and risk assessment. Structural causes such as significant aortic stenosis may need intervention, discussed on an individual basis in a specialist setting.

Across all causes, addressing anxiety (both as a cause and as a consequence of chest pain) is an important part of management. Helping a young person understand that their pain does not signal heart disease, and supporting them to resume normal activity, makes a real and measurable difference to their quality of life.

Frequently Asked Questions

Is chest pain in children ever caused by the heart?

Yes, but not commonly. Cardiac causes account for fewer than five per cent of chest pain presentations in children and teenagers. The majority of cases have a musculoskeletal, gastrointestinal, respiratory, or psychological cause. The purpose of specialist assessment is to identify the rare cardiac cases reliably and reassure the majority.

My child says their heart hurts. Does that mean it is a heart problem?

Not usually. Children often use the phrase “my heart hurts” to describe chest pain of any origin, including chest wall pain or indigestion. The location of the description does not tell us the source of the pain. A careful history and examination are far more informative than the child’s own interpretation of where the pain is coming from.

Should I take my child to A&E with chest pain?

If your child has chest pain during exercise, fainting, palpitations, racing heartbeat, pain radiating to the arm or jaw, or significant breathlessness, go to A&E or call 999.

What is costochondritis and how long does it last?

Costochondritis is inflammation of the cartilage connecting the ribs to the breastbone. It produces tenderness that is reproducible on pressing the affected area. Episodes can last several weeks and occasionally longer. Ibuprofen taken regularly for one to two weeks is usually effective. The condition is entirely benign.

Can anxiety really cause chest pain?

Yes. Anxiety is one of the more common causes of recurrent chest pain in adolescents and is a real physical phenomenon, not an imagined one. The chest muscles can tighten, the breathing pattern can change, and the pain that results is genuine. Addressing the underlying anxiety through psychological support or school-based interventions usually resolves or greatly reduces the pain.

My child has a known heart condition and now has chest pain. What should I do?

A child with a known cardiac condition who develops chest pain should see their cardiologist promptly. This does not mean the pain is cardiac in origin. Even in children with heart conditions, most chest pain is musculoskeletal or gastrointestinal. That said, the assessment needs to happen in a specialist context. Dr. Giardini sees children with complex and inherited cardiac conditions across his private clinics in London.

Can chest pain in children be caused by COVID-19?

Yes. COVID-19 infection can trigger myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the sac around the heart). Post-COVID myocarditis in children is rare but well documented. Clinicians have also identified myocarditis as a rare complication of mRNA COVID vaccination, particularly in adolescent males, though rates are low and most cases are mild and self-limiting. Any child who develops chest pain following recent COVID illness or vaccination, accompanied by breathlessness, palpitations, or fatigue, needs an ECG and a cardiology review.

Dr. Alessandro Giardini, MD, PhD