Pediatric Chest Pain

Gal Barbut; Joshua P. Needleman

doi:10.1542/pir.2019-0058

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Gal Barbut, MD*
Joshua P. Needleman, MD*

^*Maimonides Children’s Hospital, Brooklyn, NY

AUTHOR DISCLOSURE
Drs Barbut and Needleman have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

ECG:: electrocardiogram
NSAID:: nonsteroidal anti-inflammatory drug
SCAMP:: standardized clinical assessment and management plan

Education Gaps

Lack of familiarity with a systems-based approach and differential diagnosis of chest pain in pediatric patients may lead to inappropriate use of electrocardiography and echocardiography. Clinicians should be aware of the various causes of chest pain in children and the current guidelines and algorithms being used to determine which children are at risk for cardiac chest pain and should have further testing performed.

Objectives

After completing this article, readers should be able to:

Be familiar with a system-based differential diagnosis of pediatric chest pain and specific diagnosis within each system.
Understand the initial approach to assessing chest pain in a pediatric patient.
Identify when echocardiography should be used to further assess chest pain.
Understand the appropriate use criteria for echocardiography as clinical practice guidelines as well as the use of standardized clinical assessment and management plans.
Be familiar with specific questions to identify patients at risk for sudden cardiac death.

Introduction

Chest pain is a common complaint in the pediatric population, encountered in both outpatient settings and emergency and urgent care settings. There are numerous causes of chest pain in children, with most studies ultimately not determining an etiology (1) or attributing the pain to musculoskeletal causes. The complaint may be anxiety provoking for patients, their families, and care providers alike because a cardiac cause is often feared (2)(3)(4); however, the incidence of a cardiac-related cause for chest pain in the pediatric population is exceedingly low, ranging from 0.2% to 1% of cases. (5)(6)(7) Most etiologies of chest pain in pediatric patients can be grouped into musculoskeletal, pulmonary, gastroenterologic, psychogenic, or cardiac causes. Despite …