With the advent of winter, with the high incidence of respiratory diseases such as viruses, influenza and mycoplasma pneumonia, the number of children and adolescents who have recently visited the hospital for chest pain has increased significantly. Is chest pain caused by coughing?Or is there another reason?When should I take my child to the doctor as soon as possible?
Musculoskeletal problems often cause chest pain.
Not long ago, a 15-year-old girl with a painful face came to the doctor, complaining of pain in the right side of her chest, and it began to appear after a violent cough one day, and now it hurts as long as she coughs, and she has been coughing for 1 month. Usually it doesn't hurt to press, but it hurts to turn around. On examination, the patient had a serratus anterior strain, and the pain gradually eased with rest after cough suppression.
This type of muscle strain and strain is a common occurrence of chest pain caused by musculoskeletal problems, and can be triggered by trauma and overuse. Commonly affected muscles include the intercostal, pectoral, internal oblique, external abdominal, and serratus anteriors. Children usually have exercise, but this can also occur after coughing. **Approach is similar to that of most muscle strains, proper rest and stretching are essential for recovery, and NSAIDs can be used under the guidance of a pediatrician if necessary.
Another common type of musculoskeletal problem that triggers chest pain** is costochondritis, which is a self-limiting inflammation of the parasternal costochondral junction that tends to be intermittent and worsens with compression, and may radiate to the chest wall.
A 16-year-old boy had come to the thoracic surgery clinic with worsening left anterior chest pain. The patient had pain in the second rib on the left side of the sternum, which was significantly worse after compression, and he often stayed up late at night, and was diagnosed with costochondritis. Costochondritis is most commonly affected at the junction of the second to fifth costochondral cartilage,** which is mainly supportive.
Children with complex medical conditions are more likely to have chest pain.
Respiratory infections in children and adolescents, particularly pneumonia, may cause pleural irritation and may present with chest pain. Children with complex medical conditions are more likely to have chest pain.
Pleuritic pain is also common in children and can cause severe, crampy chest pain with fever due to its infectious nature**. The disease, despite its initial pain, resolves on its own within a few weeks, with analgesics as needed.
Asthma, especially exercise-induced asthma, can also cause chest pain in children, but only in a small number of children with asthma** symptoms are more pronounced if the child does short, strenuous exercise without adequate warm-up. Therefore, such children should try to avoid this situation.
Chest pain in children is also sometimes associated with digestive tract disorders. The author once treated a 12-year-old primary school student, who complained of chest pain, accompanied by heartburn from time to time, and found no musculoskeletal problems after examination.
Relevant studies have shown that there are 18%-5.Chest pain is present in 0% of children with gastroesophageal reflux, and older children and adolescents are more likely to describe chest pain. When pain caused by reflux is experienced, it is usually described as in the middle of the chest, or accompanied by a burning sensation. Reflux, infections, certain medications and allergies can sometimes trigger esophagitis, which can cause damage to the tissues of the esophagus. Occasionally, retrosternal pain or pressure and dysphagia may occur with ingestion of a foreign body, and are common in children under 5 years of age.
Chest pain due to myocarditis requires extreme vigilance.
In pediatric patients, heart disease causes the lowest proportion of chest pain, which is generally divided into non-ischemic and ischemic causes. During the period of high incidence of respiratory diseases, myocarditis and pericarditis caused by related viruses need to be extra vigilant.
A few days ago, a 9-year-old girl was sent to the emergency department because of chest pain after flu fever, and the child suffered respiratory and cardiac arrest during the blood draw. The child was diagnosed with myocarditis, a very dangerous disease. After several days of rescue, the child's condition gradually stabilized, and he was finally discharged from the hospital.
Myocarditis may present with a range of nonspecific symptoms, such as flu-like symptoms or chest pain, and may also present with significant heart failure and shock. Most cases may initially be attributed to a respiratory condition, including asthma, pneumonia, or sepsis. Children under 10 years of age may have fewer complaints of chest pain than children over 10 years of age.
Similar to myocarditis, pericarditis is often caused by viral or idiopathic causes. Pericardiac fibropericardial inflammation usually occurs in children with chest pain and fever, which tends to occur retrosternum, occurs suddenly, and worsens with inspiration. Patients with pain that worsens in the supine position and is relieved when they sit upright and lean forward, and should seek medical attention promptly when this occurs.
Psychological factors can also contribute to chest pain.
In the first cause of chest pain in children, the psychological factors are often overlooked. The author once treated a 16-year-old man who came to the doctor due to chest and back pain in the past one month. Patients report intermittent pain, sometimes on the left chest or on the right chest or back, dizziness and nausea during pain, and recent poor sleep, falling asleep less than 3 hours per night. However, his physical examination revealed no obvious problems, and the chest CT was unremarkable.
During the visit, the author found that the patient's fingernails on both hands were bitten and broken, and asked him what was bothering him and how he was digesting recentlyThe young man said that he was preparing for the study abroad exam, and he had taken the TOEFL once before, and his score was not good, and he was under a lot of psychological pressure. He has always had excellent academic performance since he was a child, and he skipped a grade to high school after only one year in junior high school, and his parents have high expectations for him.
After diagnosis, the patient's chest pain was more caused by psychogenic reasons, and the anxiety factor needed to be removed, and parents should try to help the child reduce the psychological burden.
Studies have found that the increased incidence of chest pain in children and adolescents over 12 years of age may be due to the fact that some people have experienced new stressful events, such as family changes, major illnesses or accidents, school changes, etc., and the resulting anxiety may be the potential main cause of pain. In daily life, parents should pay more attention to their children, and mental health is equally important.
The author is an attending physician in the Department of Thoracic Surgery, Beijing Jishuitan Hospital, Capital Medical University
Xie Hao **China Youth Daily.