Oct 14, 2019

Interview Transcript

Dr. Gellner: When a child tells their parents they have chest pain, parents automatically think it's a heart problem or pneumonia. While those can be the cause, it's much more likely to be something more benign, like costochondritis or precordial catch syndrome.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Chest pain is one of those things that strikes fear in the parents. They want x-rays and EKGs and echocardiograms to make sure their child's heart is okay. The good news is if your child is going to have a worrisome heart problem, there's a good chance the OB will pick it up before the baby is even born. The heart is one of those organs that OBs scan during prenatal ultrasounds.

Something missed on that, well, the next heart test is actually done on babies 24 hours after birth. In most nurseries, this is the screen for the critical congenital heart defects. We call it the CCHD screen because it's easier. This checks the oxygen level in one arm and one leg on a baby after 24 hours old when the circulation has transitioned from fetal circulation, where the blood mostly bypasses the lungs before a baby is born, to newborn circulation. The change starts as soon as the baby takes the first breath after birth.

If the baby fails this CCHD test, they are transferred to the newborn intensive care unit, where a cardiologist gets involved to do an echocardiogram, which is an ultrasound of the heart. And they'll do an EKG to check the electrical rhythm in the baby's heart.

So if the problem isn't the heart and your child's lungs are good, then the pain is most likely coming from the ribs and muscles in your child's chest. There are two very common causes of chest pain in kids -- costochondritis and precordial catch syndrome.

Costochondritis is basically inflammation of the joints that connect the ribs to the breastbone or sternum. These joints move against each other every time your child breathes. Just like any other joints, if they are overworked, they can become irritated and they can hurt, and this causes pain along the front of the chest. We see this often when kids have been coughing a lot or breathing hard. Even laughing too much can cause it. Sometimes we have no idea what triggered the inflammation. But the good news is that costochondritis eventually goes away on its own.

The other common cause of chest pain in kids is something called precordial catch syndrome or PCS. It feels like someone is stabbing you right at the base of your heart, where you can feel your heart beat best on your chest. It's brief, sharp, and can sometimes take your breath away, but it's not dangerous. Doctors aren't really sure what causes it, and it does get worse if a person breathes in deeply, but it goes away quickly.

Pediatricians normally can tell you if your child has one of these just by asking questions about your child's symptoms and doing a physical exam. No special tests are needed unless there are other concerns that raise red flags for us. And then, we may do an x-ray or an EKG.

So how do you help your child if they have one of these going on? If your child has costochondritis, rest, ibuprofen, and avoiding heavy exercise or lifting for a few days does the trick. If your child has PCS, you don't need to do anything in particular to treat it because it doesn't really interfere with normal activity.

With both of these diagnoses, kids can continue to be kids. They can go to school. They can do all the fun things they want to. Quite often, just knowing what is going on and that they don't have anything dangerous is reassurance enough for the kids and their parents.

So if your child says they have chest pain, it's always a good idea to have your child's pediatrician get a good history and do a thorough exam to help you figure out what the real cause is.

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