condition is not suspected, ordering unnecessary tests may actually increase a patient’s or parent’s concern that true pathology exists Definitive ongoing management requires referral to a primary care physician SUMMARY Chest pain in children is a relatively uncommon sign of serious disease, but often has great importance to the patient or family Most cases can be diagnosed by the emergency physician from the history and physical examination alone Most all cardiac causes of chest pain can be diagnosed from the full history, physical examination, and EKG Selective use of chest radiography and labs including troponin may be warranted in specific cases The physician should always consider drug-induced chest pain and other life-threatening conditions Patients with a history of exercise-induced chest pain, palpitations and/or syncope, medical history of underlying cardiopulmonary condition, suspected Kawasaki disease, collagen vascular disease, connective tissue disorders, hyperlipidemia, malignancy, thrombophilia, myopathies, history of drug use, oral contraceptive and cigarette use, and family history of sudden death, early coronary artery disease, cardiomyopathy, hypercholesterolemia, hypercoagulability disorders, hyperlipidemia, and pulmonary hypertension appear to be at higher risk of cardiovascular disease and warrant cardiology evaluation Psychogenic chest pain is a common occurrence and may be chronic or related to an acute stressful event The possibility of cardiac disease needs to be addressed directly by the examining physician to alleviate fully the patient’s (or family’s) anxiety The most common causes of organic chest pain are musculoskeletal (traumatic or inflammatory) and infectious disorders, usually self-limited or easily treated diseases Occasionally, serious abdominal, pulmonary, or cardiac problems require immediate attention Suggested Readings and Key References Angoff GH, Kane DA, Giddins N, et al Regional implementation of pediatric cardiology chest pain guideline using SCAMP methodology Pediatrics 2013;132:e1010–e1017 Brown JL, Hirsh DA, Mahle WT Use of troponin as a screen for chest pain in the pediatric emergency department Pediatr Cardiol 2012;33:337–342 Cava JR, Sayger PL Chest pain in children and adolescents Pediatr Clin North Am 2004;51:1553–1568 Dalal A, Czosek RJ, Kovach J, et al Clinical presentation of pediatric patients at risk for sudden cardiac arrest J Pediatr 2016;177:191–196