PALS Training to the Rescue – Chest Pain in Children

Occasionally, children complain that their “chest hurts”. Of course, with an adult, one would automatically assume “chest pain” signifies heart problems. But is this the case with children’s complaints of chest discomfort?

Fortunately, children typically do not have cardiac related chest pain. There will always be the exception and when cardiac involvement is suspected, a 9-1-1 call is appropriate activating the Pediatric Advanced Life Support (PALS) protocols and possibly saving the child’s life.

Should your child complain of pain to his chest, you can breathe easy knowing the cause will most likely be benign in origin. Common causes identified by Cincinnati’s Children’s Hospital are among the following:

– Costochondritis: inflammation that occurs within the “joint” between the rib and breastbone. This symptom is caused with upper respiratory viral illness or frequent coughing and is usually treated with anti-inflammatory medications such as ibuprofen.

– Injury: impact (which can be serious) or strain with frequent coughing, contact sports or falls can create discomfort to the chest. Treatment depends on the extent of the injury that is minor in nature is generally supportive in nature with rest and over-the-counter pain medications. All injuries to the chest should be evaluated by a physician particularly when difficulty breathing is associated.

– Stress and Anxiety: a condition typically associated with adults, children can also suffer from the side effects of perceived stress or worry. Determining the cause of this type of discomfort aides in recognizing possible interventions for treatment.

– Precordial Catch Syndrome: a rare condition that typically affects adolescents in which a sudden onset of sharp pain associated with inspiration occurs along the chest or back. This condition has no significant side effects and generally resolves itself within moments. (information obtained the Cincinnati Children’s Hospital website)

Parents can breathe easy knowing chest pain occurring in children is rarely cardiac in origin. However, a few rare circumstances may indicate heart involvement in children.

Uncommon to children is the complaint of chest pain that is related to cardiac injury or illness. Typical pediatric chest pain complaints are due to minor injury, illness or even stress. But when there is a cardiac cause for a child’s chest pain, serious concerns can be raised.

Cincinnati Children’s Hospital lists a few of the very rare causes of pediatric cardiac pain. Infrequent in presentation within the pediatric population, the occasional conditions listed below can occur.

– Pericarditis: an inflammation of the lining surrounding the heart. Symptoms are usually sharp chest pain around the sternum, occasionally radiating to the shoulders. The cause of pericarditis is generally from infection and can usually be treated with antibiotics.

– Coronary Artery abnormalities: usually a congenital caused condition, symptoms mimic those found in adult chest pain. Acquired diseases such as Kawasaki’s disease can also be an underlying condition for this type of chest pain and treatment will depend on the nature of the condition itself. Seeking prompt treatment from a physician is required.

– Mitral Valve Prolapse: a mild abnormality of the heart valve in the left ventricle of the heart. Symptoms are generally benign and treatment is determined by the physician, usually left to run an uncomplicated course.

These are only three possible causes of pediatric chest pain. Other causes can include an over-increase in fluid or air causing discomfort, inflammation in the chest and possible illnesses of the lungs or asthma. Astute monitoring of chest discomfort in children is necessary to rule out cardiac origin, even with the rare occurrence of such in children. Calling 9-1-1 to activate pre-hospital assistance and the Pediatric Life Support (PALS) protocols is the first and most appropriate step to take when suspicion of cardiac chest pain occurs in a child.