Children's Hospital Colorado

Chest Pain

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • Pain or discomfort in the chest (front or back)
  • The chest includes from the top to the bottom of the rib cage

Causes of Chest Pain

  • Muscle Overuse. Chest pain can follow hard sports (such as throwing a baseball). Lifting (such as weights) or upper body work (such as digging) can also cause it. This type of muscle soreness often increases with movement of the shoulders.
  • Muscle Cramps. Most brief chest pain lasting seconds to minutes is from muscle cramps. The ribs are separated by muscles. These fleeting pains can also be caused by a pinched nerve. These chest wall pains are harmless. Brief muscle cramps are also the most common cause of recurrent chest pains. The medical name is precordial catch syndrome.
  • Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.
  • Asthma. Children with asthma often have a tight chest. They may refer to this as chest pain. They also get chest pain when they have lots of coughing.
  • Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone).
  • Caffeine. A rapid and pounding heart beat may be reported as chest pain. Too much caffeine as found in energy drinks is a common cause. Drugs prescribed for ADHD also can cause a fast heartbeat. Illegal drugs, such as cocaine, can cause a high heart rate as well.
  • Chest Wall Injury. Blunt trauma usually just causes a bruised rib. Sometimes, it causes a rib fracture.
  • Heart Disease (Serious). Heart disease is hardly ever the cause of chest pain in children. Chest pain that only occurs with exercise could have a cardiac cause.
  • Pleurisy (Serious). Pleurisy is a complication of pneumonia. If the infection involves the lung's surface, that area of the chest will hurt.

Pain Scale

  • Mild: Your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
  • Moderate: The pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
  • Severe: The pain is very bad. It keeps your child from doing all normal activities.

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out (fainted)
  • Bluish lips or face
  • Not moving or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Severe constant pain (child not able to move or do anything)

Call Doctor Now or Go to ER

  • Your child has heart disease
  • Trouble breathing, but not severe
  • Taking a deep breath makes the pain worse
  • Heart is beating very rapidly
  • After a direct blow to the chest
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Fever is present
  • Cause of chest pain is not clear. (Exception: Pain due to coughing, sore muscles, heartburn or other clear cause)
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Chest pains only occur with hard exercise (such as running)
  • Sore muscles last more than 7 days
  • Heartburn lasts more than 2 days on treatment
  • Chest pains are a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Normal chest pain from sore muscles
  • Normal chest pain from heartburn

Care Advice

Sore Muscle Pain Treatment

  1. What You Should Know About Mild Chest Pain:
    • Chest pains in children lasting for a few minutes are usually harmless. The pain can be caused by muscle cramps. They need no treatment.
    • Chest pains that last longer can be from hard work or sports. The shoulders are usually involved. Sore muscles can start soon after the event.
    • Here is some care advice that should help.
  2. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
    • Continue this until 24 hours have passed without pain.
  3. Cold Pack for Pain:
    • For the first 2 days, use a cold pack to help with the pain.
    • You can also use ice wrapped in a wet cloth.
    • Put it on the sore muscles for 20 minutes, then as needed.
    • Caution: Avoid frostbite.
  4. Use Heat After 48 Hours:
    • If pain lasts over 2 days, put heat on the sore muscle.
    • Use a heat pack, heating pad or warm wet washcloth.
    • Do this for 10 minutes, then as needed.
    • Reason: Increase blood flow and improve healing.
    • Caution: Avoid burns.
    • A hot shower may also help.
  5. Stretching the Muscles:
    • Gentle stretching of the shoulders and chest wall may help.
    • Do sets of 10 twice daily.
    • This may prevent muscle cramps from coming back.
    • Stretching can be continued even during the chest pain. Do not do any exercises that increase the pain.
  6. What to Expect:
    • For sore muscles, the pain most often peaks on day 2.
    • It can last up to 6 or 7 days.
  7. Call Your Doctor If:
    • Pain becomes severe
    • Pain lasts over 7 days on treatment
    • You think your child needs to be seen
    • Your child becomes worse

Heartburn (Reflux) Pain Treatment

  1. What You Should Know About Heartburn:
    • Heartburn is common.
    • It's due to stomach acid going up into the esophagus. The esophagus is the tube from the mouth to the stomach.
    • Heartburn causes a burning pain behind the lower part of the breastbone. It also causes a sour (acid) taste in the mouth and belching.
    • Here is some care advice that should help.
  2. Antacids:
    • Heartburn is usually easily treated. Give a liquid antacid by mouth (such as Mylanta or the store brand). No prescription is needed.
    • Dose: Give 1 to 2 tablespoons (15 - 30 ml).
    • If you don't have an antacid, use 2 to 3 ounces (60 - 90 ml) of milk.
    • For heartburn that keeps coming back, give an antacid 1 hour before meals. Also, give a dose at bedtime. Do this for a few days.
  3. Heartburn Prevention:
    • Do not eat too much at meals. This overfills the stomach.
    • Do not eat foods that make heartburn worse. Examples are chocolate, fatty foods, spicy foods, carbonated soda, and caffeine.
    • Do not bend over during the 3 hours after meals.
    • Do not wear tight clothing or belts around the waist.
  4. What to Expect:
    • Most often, heartburn goes away with treatment.
    • But, heartburn also tends to come back. So, preventive measures are important.
  5. Call Your Doctor If:
    • Heartburn doesn't go away after 2 days of treatment
    • You think your child needs to be seen
    • Your child becomes worse

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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Copyright 1994-2017 Schmitt Pediatric Guidelines LLC. All rights reserved.

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