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Chest Pain in Children: Is It Another "Growing Pain"?
Mia Kassab1,2, Abhay Katyal1,2, Sonia Franciosi1,2
1Department of Pediatrics The University of British Columbia Vancouver British Columbia Canada.
Insights
Pediatric chest pain is usually non-cardiac, with musculoskeletal causes being most common. Differentiating benign pain and identifying somatization is key for effective treatment.
Area of Science:
- Pediatric Medicine
- Cardiology
- Gastroenterology
Background:
- Chest pain is a frequent pediatric complaint, with 99% of cases having non-cardiac origins.
- Musculoskeletal causes are the most prevalent non-cardiac chest pain etiologies in children.
- Existing diagnostic labels for musculoskeletal chest pain may be applied too broadly.
Purpose of the Study:
- To review proposed etiologies of pediatric chest pain.
- To evaluate the evidence supporting current diagnostic and management approaches.
- To differentiate benign musculoskeletal chest pain from pain with unidentified causes.
Main Methods:
- Comprehensive literature review of pediatric chest pain etiologies.
- Analysis of diagnostic criteria and clinical examination findings.
- Evaluation of emerging treatment modalities, including psychiatric and mindfulness-based interventions.
Main Results:
- Musculoskeletal chest pain is the most common non-cardiac cause in children.
- Accurate diagnosis requires a detailed history, physical exam, and potentially an electrocardiogram and laboratory tests.
- Chest pain without an identifiable cause may indicate somatization, benefiting from psychiatric evaluation.
Conclusions:
- Providers must differentiate benign musculoskeletal chest pain from undiagnosed causes.
- Objective physical findings or a plausible history are crucial for diagnosing musculoskeletal chest pain.
- Emerging interventions like mindfulness may benefit children with somatization-related chest pain.
Abstract:
Chest pain is a common complaint among children that has a non-cardiac origin in 99% of pediatric cases. We conducted a literature review of the different proposed etiologies of pediatric chest pain, as well as the evidence base supporting current approaches. Among the non-cardiac causes of chest pain in children, musculoskeletal causes are reported to be the most prevalent. This includes precordial catch syndrome, Tietze's syndrome, and costochondritis. However, these origins of musculoskeletal chest pain were described historically, and their labels are likely applied too broadly. It is important that providers be able to differentiate between benign chest pain that truly has a musculoskeletal origin and that which lacks an identifiable cause. To determine the cause of chest pain, providers should take a detailed history, physical examination, electrocardiogram, and any additional indicated laboratory tests. Musculoskeletal chest pain should only be diagnosed if there is an objective finding of reproducible tenderness during the physical examination or if there is a plausible history. If no cause can be identified, the chest pain may be linked to somatization. As a result, these patients may benefit from psychiatric evaluation and mindfulness-based interventions. To better inform clinical care, providers should be aware of these emerging management approaches.
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