Symptom Definition

• Pain or discomfort in the chest (front or back). This includes the area from the lower neck to the bottom of the rib cage.
  

Causes

• Most persistent chest pain is from a hacking cough.  Coughing can cause sore muscles in the chest wall, upper abdomen or diaphragm.  Occasionally, chest pain follows strenuous exercise, lifting (e.g. weights or heavy boxes), or work that involves the upper body (e.g., digging).  This type of muscle soreness often increases with movement of the shoulders.  Most brief chest pain lasting minutes is from harmless muscle cramps or a pinched nerve.  Heart disease is hardly ever the cause of chest pain in children.
  

See More Appropriate Topic (instead of this one) If

• Has asthma symptoms, see ASTHMA ATTACK.
  
• Caused by a cough, see COUGH.
  (To go directly to these topics, click on the links following this document.)
  

WHEN TO CALL YOUR DOCTOR FOR CHEST PAIN

Call 911 Now (your child may need an ambulance) If

• Severe difficulty breathing (struggling for each breath, grunting to push air out, unable to speak or cry or lips are bluish).
  
• Not moving or too weak to stand
  

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.
  
• Your child has heart disease.
  
• Difficulty breathing, but not severe.
  
• Can't take a deep breath.
  
• Severe chest pain.
  
• Heart beating very rapidly or has fainted.
  
• Followed a direct blow to the chest.
  
• Unexplained chest pain present longer than 1 hour (EXCEPTION:  pain due to coughing, sore muscles or other obvious cause).
  

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs an office visit.
  
• Fever is present.
  

Call Your Doctor During Weekday Office Hours If

• Sore muscles last for more than 7 days.
  
• Chest pains are a recurrent problem.
  

Parent Care at Home If

• Normal chest pain from sore muscles and you don't think your child needs to be seen.
  

HOME CARE ADVICE FOR CHEST PAIN FROM SORE MUSCLES

1.  Reassurance:  Chest pains in children lasting for a few minutes are usually harmless muscle cramps. They need no treatment. Chest pains from vigorous exercise of the upper body (sore muscles) usually start soon after the activity and need the following treatment.

2.  Pain Medicine:  Give acetaminophen (e.g. Tylenol) or ibuprofen.  Continue this until 24 hours have passed without pain.

3.  Local Heat:  Apply local heat for 20 minutes 4 times a day. Use a heating pad or warm washcloth to the area.

4.  Stretching Exercises:  Daily, gentle stretching exercises of the shoulders and chest wall in sets of 10 twice daily can prevent recurrence of these chest pains.  Stretching exercises can be continued even during active chest pain. Avoid any that increase the pain.

5.  Expected Course:  For sore muscles, the pain usually peaks on day 2 and lasts 6 or 7 days

6.  Call Your Doctor If:

• Pains last for more than 7 days on treatment.
  
• Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
  

See Other Topics:

• Asthma Attack
• Cough
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Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.




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