Dr. Alessandro Giardini
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Few things alarm a parent more than a child complaining that their chest hurts. The immediate fear (that something is wrong with the heart) is entirely understandable. Adults associate chest pain with heart attacks, and that association is hard to set aside when it is your child reporting the symptom.
Dr. Alessandro Giardini has written this guide to give parents a clear and practical understanding of chest pain in children: what causes it, what the red flags are, when investigation is needed, and when a specialist review is the right step.
Chest pain is one of the most frequent reasons children and teenagers visit a paediatric cardiologist. Research from major paediatric centres suggests that the peak age is between 10 and 21 years, with most episodes being brief, self-limiting, and benign.
Understanding the real landscape of paediatric chest pain helps enormously. The most common causes are musculoskeletal (up to 70 per cent of cases), followed by gastrointestinal, respiratory, psychogenic, and idiopathic causes. Cardiac causes, though rare, are the ones that require identification.
Chest pain is very common in children and adolescents and represents a large part of a paediatric cardiologist’s workload. As the chest is a very busy area there are many reasons for pain occurring in the chest. The most common type of chest pain is the one originating from the chest wall. The chest wall is the body structure that contains all the organs of the chest. It is made up of bones (ribs and front chest bone or sternum, cartilage, joints between the ribs and the sternum, and muscles attached to the bone). The causes for chest wall pain are unknown but strain on the muscle and bones, small trauma and inflammation are the most likely causes. Some of the characteristics of the pain are very typical: very short (one to few seconds) or very long duration (many hours up to a few days), generally sharp, changing with breathing, cough or compression on the chest. Another important feature is that chest wall pain usually disappears or improves with medications such as paracetamol or ibuprofen.
Viral or bacterial chest infections can also cause chest pain particularly if the child has an intense cough. Chest pain is also reported by some children who have acid reflux from the stomach into the oesophagus (food pipe) as they cannot describe their symptom in another, more articulate way. Stress or anxiety may also cause a complaint of chest pain and are generally associated with 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 are rare and are generally associated with other symptoms (easy fatigue, breathlessness, dizziness or fainting (particularly during or immediately after exercise), vomiting, poor feeding) or physical findings (pale colour, easy sweating, cyanosis (blue tinge on the face), or fast heart rate).
Heart conditions that can cause chest pain in a child or adolescent include: pericarditis (an inflammation of the space surrounding the heart, generally as a result of a viral infection); myocarditis (an inflammation of the heart secondary to a viral infection); arrhythmias and in particular SVT (abnormal and fast heart rate); increased strain put on the right or left sided pumping chambers (related to a narrow outflow from the pumping chamber or a narrow valve); or, rarely, inappropriate 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).
Understandably, parents often worry that there could be a problem with the heart when their child complains of chest pain. However, chest pain of cardiac origin is quite rare and other causes for the chest pain can be identified in most children. However, it is also important not to ignore chest pain in a child, particularly if it occurs during exercise, if is associated with other symptoms and if there is a family history of heart problems.
Taking a detailed history of the complaint and a thorough examination is generally enough to be able to exclude a cardiac cause. If your paediatrician is unsure about the cause of chest pain, your he/she will refer you to a paediatric cardiologist. The paediatric cardiologist will listen to your child’s heart and ask you and your child questions about the circumstances that are associated to 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 he 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.
The following features should always prompt urgent or early specialist assessment. They do not guarantee a cardiac diagnosis, but they significantly raise the index of suspicion and require investigation.
Chest pain that occurs during exercise (rather than after it) is the most important red flag. Pain that develops while a child is actively running, cycling, or playing sport warrants urgent assessment. Chest pain accompanied by fainting or near-fainting is equally concerning. Pain associated with palpitations, a racing heartbeat, or an irregular pulse requires prompt evaluation. Chest pain that radiates to the jaw, neck, arm, or back should be taken seriously. A family history of sudden cardiac death in a young relative (under 40), or a known familial cardiac condition such as HCM or Long QT Syndrome, significantly raises the importance of thorough assessment. Any child with a known congenital heart condition who develops chest pain needs a cardiology review without delay.
If your child develops chest pain with any of these features, call 999 or go directly to the nearest emergency department.
Not every episode of chest pain requires specialist cardiology assessment, but the following situations do warrant one:
Chest pain that occurs during exercise. Any episode associated with fainting, palpitations, or breathlessness. Chest pain that is recurrent or has continued for more than a few weeks without a clear explanation. A family history of sudden cardiac death, arrhythmia, or inherited cardiac conditions. A known cardiac condition in the child. A GP or paediatrician who has found a murmur or an abnormal ECG.
Even without red flags, parents who feel concerned and seek expert reassurance have every reason to request a specialist assessment. Many families who see Dr. Giardini in his private clinics are doing precisely this: seeking a clear, expert explanation.
Dr. Giardini sees children and teenagers with chest pain at several London locations. His approach starts with a detailed clinical history: spending time understanding exactly when the pain occurs, what brings it on, and what the child's cardiac and family background looks like, because this careful history is often more informative than any single investigation.
Treatment depends entirely on the underlying cause. For musculoskeletal pain, reassurance, ibuprofen, and time are almost always sufficient. Dietary modification and medication resolve acid reflux effectively. Appropriate inhaler therapy addresses asthma-related chest pain.
For cardiac causes, management is condition-specific. Clinicians treat pericarditis with anti-inflammatory medication and rest. Arrhythmias often respond to medication, and catheter ablation is an option for recurrent or troublesome episodes. Specialist teams manage HCM through a programme of monitoring, medication, and risk assessment. Structural causes such as significant aortic stenosis may need intervention, discussed on an individual basis in a specialist setting.
Across all causes, addressing anxiety (both as a cause and as a consequence of chest pain) is an important part of management. Helping a young person understand that their pain does not signal heart disease, and supporting them to resume normal activity, makes a real and measurable difference to their quality of life.
Yes, but not commonly. Cardiac causes account for fewer than five per cent of chest pain presentations in children and teenagers. The majority of cases have a musculoskeletal, gastrointestinal, respiratory, or psychological cause. The purpose of specialist assessment is to identify the rare cardiac cases reliably and reassure the majority.
Not usually. Children often use the phrase "my heart hurts" to describe chest pain of any origin, including chest wall pain or indigestion. The location of the description does not tell us the source of the pain. A careful history and examination are far more informative than the child's own interpretation of where the pain is coming from.
If your child has chest pain during exercise, fainting, palpitations, racing heartbeat, pain radiating to the arm or jaw, or significant breathlessness, go to A&E or call 999.
Costochondritis is inflammation of the cartilage connecting the ribs to the breastbone. It produces tenderness that is reproducible on pressing the affected area. Episodes can last several weeks and occasionally longer. Ibuprofen taken regularly for one to two weeks is usually effective. The condition is entirely benign.
Yes. Anxiety is one of the more common causes of recurrent chest pain in adolescents and is a real physical phenomenon, not an imagined one. The chest muscles can tighten, the breathing pattern can change, and the pain that results is genuine. Addressing the underlying anxiety through psychological support or school-based interventions usually resolves or greatly reduces the pain.
A child with a known cardiac condition who develops chest pain should see their cardiologist promptly. This does not mean the pain is cardiac in origin. Even in children with heart conditions, most chest pain is musculoskeletal or gastrointestinal. That said, the assessment needs to happen in a specialist context. Dr. Giardini sees children with complex and inherited cardiac conditions across his private clinics in London.
Yes. COVID-19 infection can trigger myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the sac around the heart). Post-COVID myocarditis in children is rare but well documented. Clinicians have also identified myocarditis as a rare complication of mRNA COVID vaccination, particularly in adolescent males, though rates are low and most cases are mild and self-limiting. Any child who develops chest pain following recent COVID illness or vaccination, accompanied by breathlessness, palpitations, or fatigue, needs an ECG and a cardiology review.
Author: Dr. Alessandro Giardini, MD, PhD
Written 09/04/2026