Child with Chest Pain: Advice for Referrers

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

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

The majority of patients will not require assessment in secondary care and reassurance, with or without simple analgesia, is usually sufficient.

Indications for referral

For a patient with acute severe chest pain please call General paediatrics via GP triage through switchboard or Consultant connect to discuss an acute assessment.

Please call Paediatric cardiology registrar (ext 84440) if you wish to discuss a patient with a known cardiac condition presenting with chest pain

Indications for referral to Medical Paediatric outpatient clinic:

Persistent concern and recurrent presentations regarding chest pain despite reassurance and simple analgesia
Associated non-cardiac symptoms for e.g. nausea, vomiting, wheeze, cough

Indications for referral to Paediatric Cardiology outpatient clinic include:

Chest pain with associated palpitations and syncope (particularly if mid-exertional)
Abnormal cardiovascular system examination
Family history of sudden death in parents or siblings (please note nationalscd.service@nhs.scot is a shared email box fo SCD/OOHCA queries across Scotland)
Family History of non–ischaemic heart disease in 1^st degree relative (please include details in referral)

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, hypercoagulable conditions/medications (OCP) 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)