How should one approach chest-pain management in the pediatric population?
—Madhu Gopal, MD, Chicago

Chest pain in children usually has a benign etiology. Most patients will have a normal physical exam or findings consistent with a musculoskeletal origin (e.g., chest-wall tenderness); these patients do not require any further investigation. Any patients with abnormal physical findings or associated symptoms that suggest organic disease, however, need further workup. Cardiac etiologies may be revealed by abnormal heart sounds or murmurs. Children with acute onset of chest pain and severe distress, abnormal vital signs, or hypoxemia require immediate intervention. A respiratory etiology will be accompanied by tachypnea and respiratory distress.

Some GI disorders, primarily those affecting the esophagus, can produce chest pain. Other causes can be traumatic, nontraumatic (e.g., costochondritis), or psychogenic (primarily in children older than 12 years). Chest pain may persist or recur, and follow-up and reassurance should be provided until the symptoms resolve.
—Michael E. Ryan, DO (111-15)

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