Introduction

Chest pain is a common symptom in paediatric practice and a frequent cause of attendance to general practitioners and hospital outpatients' departments. Public education campaigns have emphasised its potentially serious cause in adults, namely ‘a heart attack’, leading to heightened concern when it occurs in a child.1 2 However, in children it is typically benign and self-limiting, not usually a manifestation of organic disease, and rarely cardiac in origin.1,–,11 The patients are often referred by their general practitioner or local accident & emergency department to general paediatricians, respiratory paediatricians or paediatric cardiologists. Chest pain is in fact the second most common cause of referral to paediatric cardiologists in the USA,6 murmurs being the largest.12 The exact cause of chest pain often remains undiagnosed13 and is labelled as ‘idiopathic’.1 3,–,6 9 11 14

There are a number of chronic conditions known to be associated with recurrent chest pain, for example cystic fibrosis and sickle cell disease. This article will not discuss these conditions as the underlying diagnosis is usually known. There are a number of acute causes of chest pain, for example pneumothorax or empyema, that are not usually recurrent and where the child is often unwell, so they will also not be discussed. Of course all recurrent cases will, at one point, have to present for the first time, so acute causes will sometimes need to be considered at the initial presentation. This article will highlight the most likely causes of recurrent chest pain in a child who is otherwise well, although the full differential diagnosis is long (table 1).