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Child with Chest Pain: Advice for Referrers

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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)
Useful resources for parents

Managing Emotions | NHS GGC

Costochondritis - NHS (www.nhs.uk)

RHC Gastro-oeophageal reflux leaflet

Useful resources for GPs

Collins SA, Griksaitis MJ, Legg JP. 15-minute consultation: A structured approach to the assessment of chest pain in a child Arch Dis Child Educ Pract Ed 2014: 99: 122-126 

Chest Pain in children: when to worry and when to refer – PaediatricFOAM

Editorial Information

Last reviewed: 24 August 2022

Next review: 31 August 2024

Author(s): Laura McLaren, Consultant in Medical Paediatrics