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Chest pain in children: diagnosis through history and physical examination
J A Evangelista1, M Parsons, A K Renneburg
1Cardiovascular Program, Children's Hospital, Boston, Boston, Mass. 02115, USA.
Insights
Pediatric chest pain is common but rarely cardiac. This study found most childhood chest pain cases stem from musculoskeletal, asthma, gastrointestinal, or psychogenic causes, not heart problems.
Area of Science:
- Pediatric Cardiology
- Clinical Pediatrics
Background:
- Chest pain is a frequent and distressing symptom in children.
- It is often perceived as serious by families, posing diagnostic challenges.
Purpose of the Study:
- To identify historical and physical examination factors for diagnosing pediatric chest pain.
- To determine the causes of chest pain in a pediatric cardiology clinic population.
Main Methods:
- Prospective study of 50 children (ages 5-21) with chest pain.
- Systematic history taking, physical examination, and electrocardiogram (ECG) testing were performed.
Main Results:
- 76% of cases were musculoskeletal/costochondral chest pain.
- 12% were exercise-induced asthma, 8% gastrointestinal, and 4% psychogenic.
- All diagnosed cases were noncardiac in origin.
Conclusions:
- Pediatric chest pain is rarely of cardiac origin.
- This study supports previous findings on noncardiac causes.
- An approach to evaluation and management of pediatric chest pain is reviewed.
Introduction:
Chest pain is a common complaint in the pediatric age group and can be a physically and emotionally distressing symptom. Although chest pain in children rarely indicates serious cardiac problems, chest pain is perceived as "heart pain" to most children and their families and presents a diagnostic challenge to health care providers.
Methods:
A prospective study was conducted to identify specific factors in history taking and physical examination that permit accurate diagnosis of the cause of pediatric chest pain. Fifty children (ages 5-21 years; mean, 13 years), referred to the cardiology clinic with the chief complaint of chest pain, underwent systematic history taking, physical examination, and electrocardiogram testing.
Results:
The following diagnoses were made: 38 children (76%) had musculoskeletal/costochondral chest pain, 6 children (12%) had exercise-induced asthma, 4 children (8%) had chest pain resulting from gastrointestinal causes, and 2 children (4%) had chest pain resulting from psychogenic causes.
Discussion:
All the children in this study had noncardiac causes of their chest pain. This finding supports previous research suggesting that chest pain in children is rarely of cardiac origin. This article reviews the causes of pediatric chest pain and suggests an approach to its evaluation and management.