Should aim to identify signs of cardiorespiratory distress: Family history sudden cardiac death or arrhythmia.Risk factors for serious or life-threatening conditions Cardiac Family history of serious cardiac or pulmonary conditions (eg arrhythmia, cardiomyopathy, pulmonary hypertension, sudden death).Underlying condition (eg Duchenne muscular dystrophy).Recent illness or vaccination (eg myopericarditis secondary to COVID-19 mRNA vaccination).Associated symptoms (eg dizziness, shortness of breath, palpitations).Quality (crushing central chest pain or worse with inspiration).Reproducibility (consider exertional or positional).Timing of symptom onset (acute onset more likely to have identifiable cause).Others such as echocardiogram or CT pulmonary angiogram should be discussed with a senior clinicianĪ thorough history is key to identifying a likely cause and minimising unnecessary investigation Investigations such as ECG, CXR and blood tests should be reserved for children with risk factors identified on history and examination.In children without risk factors for serious disease (see below), the most commonly identified causes of chest pain include:.Cardiac-related causes account for as few as 1% of children who present with chest pain.Reassurance with or without simple analgesia is often all that is necessary.The goal of assessment is to rule out serious causes and manage appropriately.A serious cardiac or respiratory condition is highly unlikely to be the cause of new-onset chest pain in a previously-well child.The cause of most paediatric chest pain is unknown or self-limiting causes eg musculoskeletal pain. See also Pneumonia Primary Spontaneous pneumothorax COVID-19 Key points
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