Chest pain in children is almost always caused by something harmless. In a large study of nearly 3,500 children evaluated for chest pain, 93.3% had a non-cardiac cause. The most common culprits are muscle and bone issues in the chest wall, growing pains, anxiety, and digestive problems. That said, a small percentage of cases do involve the heart, so knowing what to look for can help you tell the difference between pain that will pass on its own and pain that needs medical attention.
Chest Wall Pain Is the Most Common Cause
The single most frequent reason children get chest pain is irritation or strain in the muscles, cartilage, or bones of the chest wall. This can happen from coughing too hard during a cold, carrying a heavy backpack, roughhousing, or playing sports. The pain is usually sharp, located in one specific spot, and gets worse when your child presses on the area or takes a deep breath.
Costochondritis, an inflammation of the cartilage connecting the ribs to the breastbone, is especially common. It typically affects the second through fifth ribs on one side of the chest. The hallmark sign is that pressing firmly on the sore spot with a finger reproduces the exact pain your child has been feeling. It can last days or even weeks, but it resolves on its own and isn’t dangerous.
Precordial Catch Syndrome
If your child suddenly clutches the left side of their chest, looks panicked for a few seconds, then goes right back to what they were doing, this is likely precordial catch syndrome (sometimes called Texidor’s twinge). It’s one of the most common causes of chest pain in otherwise healthy kids and teens, and it’s completely benign.
The pain is sharp and stabbing, felt in a tiny area just below the left nipple, usually no bigger than one or two fingertips. It appears out of nowhere, doesn’t spread to other parts of the body, and lasts anywhere from a few seconds to about three minutes. Deep breathing makes it worse, so kids instinctively take short, shallow breaths until it passes. It can feel intense enough to scare a child, but it has no connection to the heart and requires no treatment.
Anxiety and Stress
Emotional distress is a surprisingly common cause of chest pain in school-aged children and teenagers. In one study of children with non-organic chest pain, anxiety disorder accounted for 40% of cases and depression for about 22%. Other contributing factors included acute stress disorder, panic disorder, and screen or gaming addiction.
Children with anxiety-related chest pain often also report a racing heartbeat or trouble breathing. The triggers behind these episodes tend to be practical, everyday stressors: conflict at home, struggles with school, poor sleep habits, a sedentary lifestyle, or too much screen time. The chest pain is real, not faked, but it’s driven by the body’s stress response rather than a physical problem. If your child’s chest pain comes and goes without a clear physical trigger and lines up with periods of emotional difficulty, anxiety is worth considering.
Digestive Causes
Acid reflux can produce a burning pain in the middle of the chest, behind the breastbone, that rises toward the throat. This is more common in older children and teenagers than in younger kids. The pain often worsens after eating, when lying down, or with spicy or acidic foods. Some children also have nausea or upper abdominal pain alongside the chest discomfort. If your child’s chest pain tends to follow meals or happens at night when they’re lying flat, reflux is a likely explanation.
When Chest Pain Happens During Exercise
Chest pain that only shows up during physical activity deserves closer attention. Most of the time it’s still non-cardiac, caused by exercise-induced asthma, deconditioning, or a strained muscle. But exertional chest pain is one of the recognized red flags in pediatric cardiology because it can, in rare cases, signal an underlying heart issue.
One condition that can reveal itself this way is myocarditis, an inflammation of the heart muscle usually triggered by a viral infection. Children with myocarditis may have had a recent cold or stomach bug before the chest pain began. Symptoms can be subtle, ranging from vague fatigue and chest discomfort to more alarming signs like rapid breathing, a racing heart, or unusual tiredness that doesn’t match the level of activity. If your child recently recovered from a viral illness and is now complaining of chest pain during exercise, or seems unusually winded or fatigued, that combination warrants a medical evaluation.
Red Flags That Need Prompt Attention
Cardiac causes account for roughly 1% to 8% of pediatric chest pain, depending on the study. The following features raise the concern level significantly:
- Pain during exercise or physical exertion, especially if it limits your child’s ability to keep going
- Fainting or near-fainting during activity
- Pain that radiates to the jaw, left arm, or back
- A family history of sudden cardiac death, particularly in a relative under age 50
- A known blood clotting disorder
- Rapid heart rate, pale or bluish skin, or severe shortness of breath alongside the pain
- Recent high fever with new chest pain, which could suggest myocarditis or pericarditis
A child who is sitting on the couch, points to a sore spot on their chest, and can make it hurt more by pressing on it is in a very different category from a child who collapses during soccer practice with chest pain and dizziness. The first scenario is almost certainly musculoskeletal. The second needs emergency evaluation.
What Happens at the Doctor’s Office
When a doctor evaluates a child for chest pain, the visit often starts and ends with a careful history and physical exam. The doctor will ask where the pain is, when it happens, how long it lasts, and whether anything makes it better or worse. They’ll press along the chest wall to check for tenderness and listen to the heart and lungs.
If the history and exam point clearly to a musculoskeletal or other benign cause, no further testing may be needed. When something in the story raises concern, the most common next steps include an electrocardiogram (EKG) to check the heart’s electrical activity, a chest X-ray, or blood tests that measure markers of heart muscle injury. An EKG can detect inflammation of the heart, abnormal rhythms, and other cardiac problems, though it isn’t used as a blanket screening tool for every child with chest pain. It’s reserved for cases where the clinical picture suggests a cardiac cause, such as an abnormal heart rate, trouble breathing, or pain during exertion.
Chest X-rays are ordered frequently (in up to 72% of emergency visits for pediatric chest pain in some studies), but their sensitivity is low, catching only about 11% to 17% of underlying issues. Many of the conditions an X-ray could reveal, like pneumonia, can also be identified through a thorough physical exam. Blood work checking for heart muscle damage is similarly targeted: it’s useful when heart inflammation is already suspected, not as a first-line screening tool for every child who walks in with chest discomfort.
For most children, the evaluation will confirm that nothing serious is going on. The reassurance itself can be therapeutic, especially for kids whose pain is amplified by worry about their heart.