Definition

• Pain or discomfort in the chest (front or back)
• Area includes the entire rib cage
• The older child complains of chest pain
• The younger child points to or holds the chest

Health Information

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.

Causes

• 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 be causes. This type of muscle soreness often increases with movement of the shoulders.
• Muscle Cramps. Most brief chest pain lasting minutes is from harmless muscle cramps. It can also be caused by a pinched nerve.
• Coughing. Chest pain commonly occurs with a hacking cough. Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm. Asthma can cause chest pain this way.
• Heartburn. Heartburn is due to reflux of stomach contents. It usually causes a burning pain under the lower sternum (breastbone) or upper belly.
• Heart disease is hardly ever the cause of chest pain in children.

Care Advice

1. Overview:
   • 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. Sore muscles can start soon after the event. The shoulders are usually involved.
   • Here is some care advice that should help.
2. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
   • Continue this until 24 hours have passed without pain.
3. Cold Pack:
   • 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. Heat Pack:
   • 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.
   • 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.

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

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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