What Could Cause Chest Pain at Night in Children?

Reviewed by Garrett Kneese, MD, MPH

Family Medicine

In children, chest pain at night is usually not from a heart problem but can be linked to stress, anxiety, muscle strains, or a change in how their body regulates blood flow.

Explanation

When a child has chest pain at night, the cause is often due to non-heart problems. One common reason is psychogenic chest pain, which means stress or anxiety makes the child feel pain in their chest. Sometimes, a muscle strain or an inflammation of the cartilage connecting the ribs (costochondritis) can cause pain, especially when a child moves or changes position during sleep. Additionally, changes in how the body controls blood pressure and heart rate—sometimes checked using a head-up tilt test—can also cause chest pain. Though conditions like acid reflux may also be considered, heart-related chest pain is very rare in children. Most children do not have heart disease, and these symptoms usually resolve on their own or with simple treatments. It is important, however, for parents to discuss any persistent, worsening, or concerning chest pain with a doctor to ensure that the correct cause is identified and treated appropriately.

(References)

Asnes RS, Santulli R, Bemporad JR. Psychogenic chest pain in children. Clin Pediatr (Phila). 1981 Dec;20(12):788-91. doi: 10.1177/000992288102001206. PMID: 7307413.
Wang Y, Wang S, Zou R, Chen S, Li F, Wang Y, Xu Y, Wang C. The Relationship Between Unexplained Chest Pain in Children and Head-Up Tilt Test. Front Pediatr. 2022 Jun 2;10:901919. doi: 10.3389/fped.2022.901919. PMID: 35722475; PMCID: PMC9203148.
Chen L, Duan H, Li X, Yang Z, Jiao M, Sun K, Jin M. The Causes of Chest Pain in Children and the Criteria for Targeted Myocardial Enzyme Testing in Identifying the Causes of Chest Pain in Children. Front Cardiovasc Med. 2021 Mar 2;8:582129. doi: 10.3389/fcvm.2021.582129. PMID: 33738299; PMCID: PMC7960652.
Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013 Sep;163(3):896-901.e1-3. doi: 10.1016/j.jpeds.2013.05.001. Epub 2013 Jun 12. PMID: 23769502; PMCID: PMC3982288.

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