My child has chest pain! Should I be worried about their heart?

Written by: Dr Alessandro Giardini
Published: | Updated: 25/02/2020
Edited by: Cal Murphy

The chest is packed with many vital structures and therefore it is not surprising that chest pain in a child or adolescent is very worrisome for parents. When should you consult a doctor? Leading paediatric cardiologist Dr Alessandro Giardini is here to explain.

Chest pain in children and adolescents is a common worry for parents and forms a large part of a paediatric cardiologist’s work.

The heart and the lungs occupy the chest space and they are wrapped and literally protected by a complex structure composed of bone (ribs and front chest bone or sternum), cartilage, and muscles (pectoral muscles and intercostal muscles). This structure, the chest wall, is the most common site of chest pain in children and adolescents.

Chest wall pain is generally sharp, and can last from a few seconds to a few days, changing with breathing, coughing, or compression on the chest. It often improves with medications such as paracetamol or ibuprofen which improve inflammation.


Non-cardiac causes of chest pain in children

Strain on the muscle and bones, trauma and inflammation are the most likely causes.

Other non-cardiac causes of chest pain include:

  • Viral or bacterial chest infections – particularly if the child has an intense cough
  • Acid reflux – some children who have acid reflux from the stomach into the oesophagus (food pipe) cannot describe their symptom in another, more articulate way.
  • Stress/anxiety – chest pain or tightness is associated with a faster heart rate as a result of the anxious state.

With the exception of acid reflux, which sometimes can be triggered by exercise, non-cardiac chest pain generally occurs at rest.


Cardiac causes of chest pain

Cardiac causes of chest pain are less common and are generally associated with other symptoms:

  • Fatigue
  • Breathlessness
  • Dizziness/fainting – particularly during or immediately after exercise
  • Vomiting
  • Loss of appetite
  • Pallor/cyanosis
  • Fast heart rate

Heart conditions that can cause chest pain in a child or adolescent include:

  • Pericarditis (inflammation of the space around the heart)
  • Myocarditis (inflammation of the heart)
  • Arrhythmias
  • Increased strain on the heart chambers (e.g. related to a narrow valve)
  • Insufficient oxygen supply to the heart as a consequence of either an increased oxygen requirement (increased muscle mass, as in hypertrophic cardiomyopathy) or narrowing or another problem with the coronary arteries (the small arteries that carry oxygen-rich blood to the heart tissue) due to either congenital anomalies or acquired problems like in Kawasaki disease.

As the heart and lungs are essential to life, parents often worry that there could be a problem with the heart or lungs when their child complains of chest pain. However, chest pain of cardiac origin is less common than musculoskeletal causes and other causes for the chest pain other than cardiac can be identified in most children.

You should never ignore chest pain in a child, especially during exercise, if there are other symptoms, or if there is a family history of heart problems.


The work of paediatric cardiologists

One reassuring fact is that cardiac causes of chest pain can be easily identified by experienced paediatric cardiologists. Taking a detailed history of the complaint and a thorough examination is generally enough to suggest a non-cardiac cause. If the GP or paediatrician examining the child is unsure about the cause of chest pain, your child will be referred to a paediatric cardiologist for specialist assessment.

The paediatric cardiologist will listen to your child’s heart and ask you and your child questions about the circumstances that are associated with the chest pain, your child’s previous and recent medical history, and the medical history of the family. He will also generally perform an ECG (a recording of the electrical activity of your child’s heart) and an echocardiogram (a detailed ultrasound scan of the heart) in order to confirm a normal heart anatomy and function.

Sometimes, the paediatric cardiologist might recommend some further testing, such as an exercise stress test, some longer recording of your child’s heart rhythm (24 hour ECG) or some further more detailed imaging of the heart. However, the majority of children will not need any further testing as they will likely be found to have a completely normal heart.


Visit Dr Giardini's Top Doctors profile to book an appointment or learn more!

By Dr Alessandro Giardini
Paediatric cardiology

Dr Alessandro Giardini is an award-winning and leading cardiologist based at the world-renowned Great Ormond Street Hospital (GOSH) in London, specialising in paediatric cardiology. An expert on congenital heart disease, Dr Giardini is the lead of inpatient services at GOSH, and also provides outpatient consultations for all manner of heart problems in children, including palpitations, heart murmurs, chest pain, and heart valve issues. He also privately practices at The Harley Street Clinic Children's Hospital, The Portland Hospital and Chase Lodge Hospital, alongside Bupa Cromwell Hospital.

Dr Giardini's experience in congenital heart disease extends to the diagnosis and management of a wide range of defects in babies, children and adolescents. His GOSH unit has pioneered techniques including transcatheter pulmonary valve replacement and Dr Giardini's involvement in paediatric cardiac research means his patients are treated according to the latest and most successful techniques.

Dr Giardini, who is a Top Doctors 2021 award winner, also leads specialist clinics for children with paediatric hypertrophic cardiomyopathy. He's highly regarded for expertise in providing guidance for children and adolescents with documented cardiac disease and those with symptoms during exercise, such as palpitations, chest pains or fainting/syncope.  

His philosophy is a patient-centric approach, delivering treatment with compassion and understanding, and personalising his consultations and treatment to each child and their family.    ​

Dr Giardini has a medical degree and a PhD (in the pathology of heart failure in patients with congenital heart defects) from the University of Bologna's (Italy) School of Medicine. Dr Giardini went on to undergo extensive training in paediatric cardiology both in Bologna and in San Francisco, USA. He is actively involved in research, having published over 120 articles in peer-reviewed journals.  

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