Costochondritis

Chest pain in childhood is a common problem, frequently results in a doctor's office or emergency room visit, and sometimes referral to a pediatric cardiologist. Although chest pain in adults is frequently cardiac in origin, heart-related chest pain is uncommon in children.

In children who are taken to the emergency room for evaluation of chest pain, approximately 4% have a cardiac cause for their pain. So, if your child complains of chest pain or even specifically calls it heart pain, try to keep those figures in mind before you panic. The majority of chest pain episodes in childhood do not require a 911 call or a trip to the emergency room. But, if it's not the heart, what is it?

The most common causes of chest pain in childhood involve the chest wall. Of the problems that can cause chest wall related pain, benign chest wall pain of childhood is one of the most common. It is "benign" because there is no threat to life, nor does it lead to any complications, but it is painful.

The underlying cause is unknown. It may be due to a brief muscle spasm in the chest wall or it may be related to the membrane or lining between the lung and the chest wall called the pleura. There is a thin space between the pleural surfaces that is lubricated by a small amount of fluid that normally lets them move without irritating each other. Some physicians think these linings occasionally develop a little irritation or friction between them resulting in a sharp, painful sensation.

Whatever the cause, the pain from benign chest wall pain is typically described as sharp, stabbing or like being poked with a needle and can be mild to severe. Its onset is sudden and not associated with any particular activity. The pain usually lasts for seconds to as much as a minute, but can recur for an hour or so.

When the pain occurs the child may be afraid to take a deep breath, or report that he or she can't take a deep breath. The location of the pain can be anywhere in the chest, but it is not unusual for the child to point to their heart or say that their heart hurts. The episodes can occur daily, weekly or monthly. They may disappear for months, but recur over several years.

In otherwise healthy children, the diagnosis of benign chest wall pain can usually be made by your doctor by the history alone and physical examination. Additional diagnostic tests are not usually necessary. The children should not be restricted from physical activity, chores or school.

Giving medications such as ibuprofen or acetaminophen are generally not helpful, because the pain usually comes and goes quickly. The best treatment is usually reassurance that, although the pain is real, it is not serious.

There are other causes of chest wall pain in childhood that do benefit from analgesics or anti-inflammatory agents. These include bone or muscle pain caused by physical strain or trauma and costochondritis.

Costochondritis is an inflammation of the rib margins at their attachment to the sternum or breastbone that can result in swelling, tenderness and redness over the areas involved. Pain of this type can be reproduced by pushing on the chest wall. Pain from structures within the chest such as the lungs, heart and esophagus will not be reproduced by pushing on the chest wall, and warrant more concern.

Pain resulting from organs within the chest cavity usually has different characteristics, and is often associated with abnormal physical examination findings. Chest pain that is associated with any of the following characteristics should not be ignored, should prompt a call to your doctor, and may require evaluation in the emergency room.

Chest pain that is almost always brought on by exercise or is associated with nausea, vomiting, sweating, weakness, fainting or irregular heart beats deserves medical attention and increases the concern for cardiac disease. Chest pain associated with coughing or shortness of breath is more likely to be a sign of asthma or other lung problems, but can be caused by heart problems.

Fever associated with chest pain can be a sign of infection related to the lungs or heart. Gastroesophageal reflux (food going from the stomach into the esophagus), indigestion or heartburn can also cause pain that is felt in the chest and may be associated with nausea and vomiting.

Chest pain that awakens children from a sound sleep is also of more concern for a significant underlying problem. Depending on the symptoms described and findings on physical examination additional diagnostic testing is likely to be recommended by the examining physician.

Chest pain, whatever the cause, is frequently scary to both the child and the parent. After evaluation most episodes of chest pain can be treated simply either by reassurance, or with ibuprofen or acetaminophen. Fortunately, for children, parents and doctors life threatening causes of chest pain are uncommon in childhood.

Dr. Denfield is a board certified pediatrician and pediatric cardiologist practicing at the Texas Children's Hospital, Houston, TX. She is also an Assistant Professor of Pediatrics at Baylor College of Medicine. She has written articles and contributed to books on pediatric cardiology.

COPYRIGHT 2003 Pediatrics for Parents, Inc.
COPYRIGHT 2003 Gale Group