Child with Chest Pain: Advice for Referrers

Chest pain is a common presenting symptom in childhood, it is rarely associated with serious underlying pathology but it can cause worry for children and their families.

Up to 56% of chest pain in children is musculoskeletal. Other causes, in descending order of frequency, include respiratory disorders, anxiety, gastrointestinal conditions, and finally cardiac at less than 1%.

Indications for referral

Indications for referral include:

Chest pain on exertion
Associated palpitations
Chest pain and syncope
Abnormal cardiac examination
Family history of sudden death or cardiac problems in young adults
History of Kawasaki disease or connective tissue disorder

For chest pain in patients with known cardiac disease:

Contact cardiology either via switch board to talk with the Cardiology Registrar or via SCI gateway referral to Paediatric Cardiology

Please include the following points from history in the referral letter

Associated symptoms - syncope, pallor, sweating, palpitations
Respiratory or gastrointestinal symptoms
Relief with analgesia?
Significant family history including sudden death in young adults or death of unknown cause
Other medical conditions e.g. connective tissue disorders or past medical history of cardiac disease e.g. Kawasaki disease

Please include the following points from the clinical examination in the referral letter

Is there tenderness on palpation?
Presence of a heart murmur?
Heart rate and BP (if possible)

Suggestions for management whilst waiting for outpatient appointment

Treat gastro-oesophageal reflux symptoms with gaviscon or PPI (Omeprazole, first line treatment)
Treat respiratory disorders as indicated
Musculoskeletal pain will improve with rest and NSAIDS
Manage anxiety-induced episodes with simple measures such as mindful apps (see link below)