Abdominal pain, leg pain (“growing pains”), headache, and chest pain are common symptoms in children and adolescents. In a prospective study, 43 children with chest pain presenting to a children’s hospital outpatient/emergency room over a 9-week period were evaluated. In this study, the occurrence rate per hospital visit was 0.288%, and in another study it was 0.249%. Chest pain accounts for 650,000 physician visits per year in patients aged 10 to 21 years.

Chest pain creates considerable angst among patients and their families because they assume that chest pain indicates heart pain. Indeed, most patients describe the pain as “my heart hurts” rather than “my chest hurts.” Fortunately, chest pain in this age-group is rarely the result of a cardiac problem. Part of the treatment of the patient involves appropriate reassurance to him/her and the family about the benign nature of chest wall pain. Useful reassurance can be given only after a careful history and physical examination.

The mean age of children and adolescents who complain of chest pain is 9 to 14 years, but this complaint can occur in children as young as 4 years. Chest pain is slightly more common in men than in women.

The relative frequency and types of chest pain reported by several investigators are summarized in Table 6.1. The most common sources of chest pain in children and adolescents are the musculoskeletal structures of the chest cage and chest wall. Several specific types of chest cage and chest wall pain can be described.