Chest Pain
Is this your child's symptom?
- Pain or discomfort in the chest (front or back)
- The chest includes from the top to the bottom of the rib cage
- If NOT, try one of these:
- Asthma Attack
- Cough
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 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 another problem 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.
When to Call for Chest Pain
Call 911 Now
Call Doctor or Seek Care Now
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Contact Doctor Within 24 Hours
Contact Doctor During Office Hours
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Self Care at Home
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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
Call Doctor or Seek Care Now
- 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
Contact 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
Contact 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
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.
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.
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.
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.
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.
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
Heartburn (Reflux) Pain Treatment
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.
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.
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.
What to Expect:
- Most often, heartburn goes away with treatment.
- But, heartburn also tends to come back. So, preventive measures are important.
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
Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2025 Schmitt Pediatric Guidelines LLC.
Reviewed: 5/6/2025 Updated: 1/25/2025
