What does a doctor do to diagnose the cause of chest pain in a child or adolescent?

When seeing a doctor for chest pain in children or adolescents, the physician follows a systematic approach to distinguish non-serious causes from conditions requiring medical intervention. The diagnosis focuses primarily on ruling out serious issues, as most cases of chest pain in children are not caused by heart problems [1]. The process begins with gathering an accurate medical history and performing a thorough physical examination, followed by additional evaluation only if necessary, based on specific clinical indicators.

Medical History and Clinical Assessment

The doctor starts by asking precise questions to understand the nature of the pain, which is the most important part of the initial diagnosis. The doctor will ask about the location of the pain (under the sternum, on one side, or radiating to the back), its duration, and how it is described (is it sharp, squeezing, or stabbing?). The doctor will also inquire if the pain increases with deep breathing, coughing, exercise, or changes in body position [1]. Parents will also be asked about the presence of any associated symptoms such as shortness of breath, dizziness, palpitations, or sweating, as well as the family history of any heart diseases or chronic health conditions.

Physical Examination and Investigating Causes

The doctor performs a careful clinical examination of the chest and heart. This includes listening to the heartbeat to detect any abnormal sounds (heart murmurs), examining the lungs to ensure breathing is normal, and applying pressure to the chest wall to determine if the pain is caused by inflammation of the muscles or cartilage (costochondritis) that connects the ribs to the sternum, which is a common cause of chest pain in children [1]. The digestive system and abdomen are also examined to rule out gastroesophageal reflux or stomach issues that may mimic chest pain [1].

Targeted Diagnostic Tests

Based on the initial assessment, the doctor may request additional tests to confirm the diagnosis. These tests are not requested for every case but depend on the severity of symptoms and clinical suspicion. These tests include:

• Electrocardiogram (ECG): To evaluate the electrical activity of the heart and rule out rhythm disorders.
• Chest X-ray: To rule out lung diseases such as pneumonia or pneumothorax.
• Blood tests: May be used to detect signs of inflammation or specific infections in the body.

For more details on conditions that warrant concern, you can visit our article on Chest pain in children and adolescents: When to worry and when to be reassured? (Arabic).

When is it an Emergency?

You must go to the emergency room immediately if the chest pain involves warning signs such as: sudden, severe pain that feels like squeezing or pressure, pain radiating to the shoulder, jaw, or arm, or if the pain is accompanied by severe shortness of breath, loss of consciousness, or a very rapid heartbeat [1]. Understanding that most causes of chest pain in children are not heart-related helps reduce anxiety, but medical evaluation remains necessary to determine the exact cause and rule out rare conditions that may pose a risk [2].

Medical references

• Chest pain
• Chest Pain