Chest pain in children. Tip-offs to cause.

The primary care physician can often delineate the cause of chest pain in a patient under 21 years of age after a thoughtful, careful, and thorough history and physical examination. Occasionally, an ECG and a chest x-ray film may be helpful. Noncardiac causes for the chest pain should be explored, and if found, the child and the parents should be assured that the problem is not serious. Occasionally, psychotherapy may be indicated. A pediatric cardiologist should be consulted when a strong family history of coronary artery disease or a personal history of coronary risk factors is present or a murmur is detected that may not be innocent. The specialist also should evaluate children who have organic cardiac disease. Finally, although the primary care physician may strongly suspect that the chest pain has little or no significance, reassurance by a pediatric cardiologist is frequently helpful to the child and the family.