My Child Says Their Chest Hurts. Is It Their Heart?

"Mom, my chest hurts."

There are certain things your child can say that immediately get your attention.

And that's definitely one of them.

Maybe your child says it while sitting on the couch watching TV. Maybe they mention it after soccer practice. Or maybe they're getting ready for bed when they suddenly tell you their heart hurts.

And immediately, your brain starts running through all the possibilities.

Is something wrong with their heart? Do we need to go to the emergency room? Should I let them go to practice tomorrow?

As a pediatrician and pediatric cardiologist, I've evaluated many children with chest pain. And as a mom, I understand why hearing those words can be scary.

So here's the first thing I want you to know:

Chest pain in children is actually pretty common. And the overwhelming majority of the time, it isn't caused by a problem with the heart.

But that doesn't mean we should ignore it.

Let's talk about what usually causes chest pain in kids, what makes me more concerned as a cardiologist, and how to know when your child needs to be evaluated.

First, kids aren't little adults.

When an adult says they're having chest pain, one of the first things we worry about is a heart attack.

But children are different.

The conditions that commonly cause heart attacks in adults are extremely rare in children.

And while children certainly can have heart conditions that cause chest pain, those conditions are much less common than parents often imagine.

In fact, most chest pain in children comes from something outside the heart entirely.

That's why, when a family comes to see me for chest pain, I'm not automatically thinking something is wrong with their child's heart.

I'm thinking about the whole chest.

The muscles. The ribs. The lungs. The esophagus. And yes, the heart.

The trick is figuring out which one is responsible.

So what actually causes chest pain in children?

There are several common causes, and most are not dangerous.

1. Muscles and cartilage (the most common culprit)

Your child's chest contains muscles, ribs, and cartilage that can all cause pain.

Sometimes children develop inflammation where the ribs connect to the breastbone. We call this costochondritis.

Other times, they've simply strained a muscle from playing sports, climbing, lifting something heavy, or coughing during an illness.

This pain may get worse when they move, take a deep breath, or press on a particular spot.

One question I often ask is:

"Can you point to exactly where it hurts?"

If a child can point to one small area of their chest, and pressing there reproduces the same pain, that can be reassuring.

It doesn't tell us everything, but it gives us a useful clue.

2. That sudden, sharp pain that comes out of nowhere

Have you ever had a quick, sharp pain in your chest that seems to catch when you take a deep breath?

Kids get this, too.

There's actually a name for it: precordial catch syndrome.

It's a common, harmless cause of chest pain in children and teenagers.

The pain is usually sharp, happens suddenly, and often gets worse when taking a deep breath.

It may last only a few seconds or a few minutes before disappearing completely.

And sometimes, just as quickly as it started, your child is back to doing whatever they were doing before.

It can be surprisingly painful, even though it isn't dangerous.

3. Asthma and other breathing problems

Sometimes what a child describes as chest pain is actually chest tightness.

Asthma can cause children to feel tightness or discomfort in their chest, particularly with exercise.

Respiratory infections and frequent coughing can also make the chest hurt.

And occasionally, conditions such as pneumonia can cause chest pain, especially when taking a deep breath.

That's why I always ask whether the pain is associated with coughing, wheezing, fever, or difficulty breathing.

4. Acid reflux

Yes, kids can get heartburn, too.

Reflux happens when stomach contents move back up into the esophagus, causing a burning sensation in the chest.

Children may describe this as chest pain, particularly after eating or when lying down.

Sometimes they'll also mention a sour taste in their mouth or discomfort in their upper abdomen.

Not every pain in the middle of the chest is coming from the heart.

5. Stress and anxiety

This is one I want to be especially careful about.

Stress and anxiety absolutely can cause physical symptoms, including chest pain.

Children experience stress differently than adults, and sometimes they don't have the words to explain what they're feeling.

But here's something important:

Just because chest pain may be related to anxiety doesn't mean the pain isn't real.

It is real.

And I never want a child to feel like we're dismissing their symptoms by saying, "It's just anxiety."

We still need to listen, ask questions, and make sure there isn't another medical explanation.

Sometimes the right treatment isn't something for the heart at all. It's helping a child manage stress, feel supported, and understand what's happening in their body.

When does chest pain make me more concerned?

Now let's talk about the part that matters most.

As a pediatric cardiologist, there are certain details that make me want to take a closer look at a child's heart.

And probably the biggest one is chest pain that happens during exercise.

There's an important difference between a child who develops chest pain after spending the afternoon climbing on the playground and a child who develops chest pain while actively running down the soccer field.

The first might be related to sore muscles.

The second deserves a closer evaluation.

Other symptoms and findings I pay particular attention to include:

• Chest pain associated with fainting or feeling like they're going to pass out

• Chest pain with unusual shortness of breath, dizziness, or a racing heartbeat

• Chest pressure that persists or keeps returning

• A child who suddenly can't keep up with activities they previously tolerated

• A known congenital heart condition or history of certain heart diseases

• A family history of cardiomyopathy, inherited heart rhythm conditions, or sudden unexplained death at a young age

These symptoms don't automatically mean a child has heart disease.

But they do mean we shouldn't simply assume the pain is harmless.

If chest pain happens during exercise, I recommend stopping the activity and arranging prompt medical evaluation before returning to strenuous sports.

And if a child has chest pain with fainting, severe difficulty breathing, persistent blue or gray lips, or severe ongoing pain, that requires emergency medical attention.

What about teenagers who complain of chest pain?

Teenagers are an interesting group because there can be several things happening at once.

They're growing. They're active. They may be playing competitive sports. They're experiencing academic and social stress.

And sometimes they're consuming more caffeine than their parents realize.

Energy drinks and large amounts of caffeine can cause a racing heartbeat or palpitations, which teenagers may describe as chest pain.

I always ask about caffeine intake when evaluating a teenager with these symptoms.

And I'm not just talking about coffee.

Energy drinks, pre-workout supplements, and other caffeinated products can all play a role.

Sometimes the conversation about chest pain turns into a conversation about sleep, hydration, stress, and what's actually in that drink they bought on the way to school.

Those conversations matter, too.

Does my child need an EKG or an echocardiogram?

Not necessarily.

And this is something I spend a lot of time explaining to families.

An EKG, or electrocardiogram, looks at the electrical activity of the heart.

An echocardiogram, often called an echo, is an ultrasound that allows us to see the structure of the heart and how blood flows through it.

Both can be useful tests when there's a reason to suspect a heart problem.

But not every child with chest pain needs an EKG, and not every child needs an echocardiogram.

Testing should be guided by the child's symptoms, medical history, family history, and physical examination.

If a child has a clear history of chest wall pain and a reassuring examination, additional cardiac testing may not be necessary.

If something about the history or examination concerns me, we can investigate further.

The goal isn't to order every test available.

It's to figure out what's going on and choose the tests that will actually help us answer the question.

What should I do when my child tells me their chest hurts?

First, pay attention to how your child looks and acts.

If they're having trouble breathing, fainting, looking very ill, or experiencing severe or persistent pain, don't wait for a routine appointment.

But if your child is otherwise comfortable and the pain is mild, there are a few things you can pay attention to that will help us figure out what's happening.

Ask them where it hurts.

Does it hurt more when they move or take a deep breath?

What were they doing when it started?

Does it happen during exercise, after eating, or when they're sitting quietly?

How long does it last?

And does anything make it better or worse?

You don't need to diagnose your child at home.

That's my job.

But those little details can be incredibly helpful when we sit down to talk about what's been happening.

For unexplained chest pain, contact your pediatrician for guidance, even if your child seems otherwise well. If the pain is recurring, worsening, or associated with other symptoms, don't put off having it evaluated.

The part I really want parents to understand

I think one of the hardest parts of being a parent is deciding when to worry.

You don't want to rush to the emergency room every time your child has an ache or pain.

But you also don't want to miss something important.

And when the symptom involves the chest, it's especially difficult not to think about the heart.

I understand that.

As a pediatric cardiologist, I also know how reassuring it can be to explain to a family exactly why their child's pain doesn't appear to be cardiac.

Not just, "Everything looks fine."

But why I'm reassured by their symptoms, their examination, and their history.

And when something does concern me, I want families to understand that, too.

Because the goal isn't to dismiss chest pain.

It's to take it seriously without automatically assuming the worst.

Most children who come to me with chest pain have healthy hearts.

And that's wonderful news.

But the best reassurance comes from understanding what's actually causing the pain, not simply being told not to worry.

So, is your child's chest pain coming from their heart?

Most likely, no.

But the answer depends on the details.

Chest pain during exercise, chest pain with fainting, or symptoms associated with an abnormal heartbeat deserve particular attention.

And if you're unsure whether your child's symptoms are something to worry about, that's a perfectly good reason to call your pediatrician.

You don't have to figure it all out yourself.

Sometimes the most important part of my job isn't finding something wrong with a child's heart. It's helping a family understand why their child's heart is okay.

And I love getting to have those conversations.

Pediatric Cardiology in Louisville, KY

I'm Dr. Meagan Peek, a board-certified pediatrician and pediatric cardiologist in Louisville, Kentucky.

I see children and adolescents for chest pain, heart murmurs, dizziness, fainting, palpitations, and other concerns involving the heart.

I'm currently seeing patients at Direct Pediatrics in Middletown, where I can combine my experience in pediatric cardiology with the personalized, relationship-based care that's always been important to me.

Whether we're investigating a symptom, deciding whether testing is needed, or simply answering the questions that have been keeping you up at night, I want you to leave understanding what's happening with your child.

Because your questions matter.

And so does your peace of mind.

Dr. Meagan Peek

Pediatrician & Pediatric Cardiologist

Direct Pediatrics – Middletown

161 S. English Station Road, Louisville, KY

502-861-6067