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When can a child’s chest pain be a sign of a broken heart?

During Heart Month, a Children’s National cardiologist shares information about when a common childhood pain might be caused by a heart issue (and when it might not).

child holding heart shaped valentine
Photo by Anna Kolosyuk

Kids complain about aches and pains all the time. But when a child complains of chest pain, it can be easy for parents to worry that this symptom could be a sign of something more serious, like a heart that isn’t working the way it should.

“While chest pain complaints should always be checked out by your child’s primary care doctor, chest pain itself is rarely related to an underlying heart issue,” says Ashraf S. Harahsheh, M.D., a cardiologist at Children’s National Hospital. “Answering a few simple questions from your child’s doctor can help determine if a referral to a cardiologist is truly necessary.”

Dr. Harahsheh says that talking with a primary care doctor about the timing of chest pain, if there were other symptoms that occurred (such as fainting or dizziness) and where the child feels the pain can be useful clues to help your pediatrician recommend the best way to care for it. During a visit for chest pain, the doctor should ask you some of the following questions:

  • Did chest pain occur during a sports activity or right after an activity ended?
  • Was there a loss of consciousness/dizziness/fainting during or after rigorous activity? What about any of these with no warning or cause known?
  • Does the pain radiate to the back, jaw, left arm or left shoulder?
  • Does the pain get worse when the child is laying down?
  • Is there fever too?

In addition, the doctor will ask you and your child about past medical history and family medical history to get a better picture of whether there are pre-existing heart issues or inherited health conditions that might contribute to chest pain.

“If the answers to the red flag questions are yes, then it is likely the family would be referred to a cardiologist,” Dr. Harahsheh notes. “But if the chest pain doesn’t meet these conditions, it may not be necessary to rush to the cardiologist. The pediatrician may recommend a different path forward to diagnose and treat the chest pain.”

In any case, Dr. Harahsheh stresses that if a child’s chest pain complaint is worrisome for a parent, it’s always a good idea to visit the primary care doctor to figure out what’s really going on. In a few cases, that might mean a cardiologist needs to take a closer look, but most often it’s something that can be managed in the expert hands of the child’s routine care provider.

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