What causes recurrent chest pain in children? A 10-year-old boy complained of chest pain over his heart that had occurred on several occasions while at rest. The pain was described as a nonradiating tightness that subsided on its own after a few minutes. The boy reported no associated dyspnea, diaphoresis, or sweating.—MUFIYDA ABRAHAM, PA-C, Jacksonville, N.C.

The three most common complaints referred to pediatric cardiology are heart murmur, chest pain, and palpitations (Curr Probl Pediatr Adolesc Health Care. 2003;33:318-347). While approximately 3%-4% of chest pain in pediatric patients is cardiac in origin (ische­mic, inflammatory, or arrhythmogenic), most chest pain in this population is noncardiac (20% musculoskeletal, 15%-20% pulmonary, 5% GI, 10% psychiatric, 15%-20% miscellaneous, and 25% idiopathic). Benign chest pain is typically sporadic, unpredictable, and nonreproducible unless associated with musculoskeletal tenderness. Findings that indicate need for further exploration and testing include visceral pain (may be severe; a sensation of crushing or pressure; or radiating, often associated with shortness of breath), pain associated with exercise, history of associated symptoms (nausea, palpitations, syncope), history of congenital findings, significant family history (sudden cardiac death or early CAD), or abnormalities on physical exam. The child described here is likely experiencing benign chest pain. One common cause is precordial catch syndrome, the etiology of which is unknown. It is important to refer those patients likely to benefit from further testing and to allay the fears of those not in danger.—Claire Babcock O’Connell, MPA, PA-C (143-3)