By Ashraf Harahsheh, MD, pediatric cardiologist based in Fairfax, Virginia
Hearing that your child may be experiencing heart-related symptoms can be scary for any parent or caregiver. Chest pain or changes in how your child feels can quickly lead to worry. The good news is that the heart is very rarely the cause of chest pain, accounting for only about 0.25% of children presenting with chest pain. Understanding what’s common, what can be managed at home, and when to seek medical advice can help guardians feel more confident and informed.
How the Heart Changes as Your Child Grows
At any age, knowing what questions to ask your child and what symptoms to observe at home can help guide next steps and ensure concerns are addressed appropriately.
During Infancy
Because infants can’t yet communicate how they’re feeling, parents rely on observation. Signs like excessive sweating, difficulty feeding, labored breathing, or fussiness during feedings may sometimes raise concern. In many cases, these symptoms are related to common issues such as reflux, but they can also signal something that deserves closer attention.
Heart murmurs are also very common in infants and are usually harmless. However, if a murmur occurs alongside symptoms like bluish discoloration of the skin or trouble finishing feedings, it’s important to have your baby evaluated promptly to rule out more serious concerns.
Starting at Age 5
By about age 5, children can begin to describe what they’re feeling and distinguish between heart-rate related sensations and chest pain. Adults can ask children, for example, how quickly their heart starts beating. A gradual increase is often normal, while a heart rate that suddenly speeds up may be worth discussing with a pediatrician.
Into Adolescence and Teen Years
As kids continue to grow into adolescence, chest pain becomes more common, but it is rarely related to the heart. Most chest pain in teens comes from non-cardiac causes, including:
- Chest wall or muscle pain: Common during growth spurts and related to the rib cage expanding. If gently pressing on the chest causes discomfort, it is likely musculoskeletal.
- Unexplained chest pain: Chest pain with no identifiable cause, often called idiopathic. While frustrating, it is not related to the heart, lungs, or esophagus.
- Organ system-related causes: These may include acid reflux (often after spicy or heavy meals), asthma or nervous system responses such as anxiety or panic attacks.
What to Expect When Visiting the Doctor
While it may seem reassuring to see a cardiologist right away, your trusted pediatrician is the best place to start. Pediatricians use evidence-based guidelines to decide whether additional testing or referral to a heart specialist is necessary. They will also clearly explain their reasoning and answer questions along the way.
Even if a referral isn’t recommended, guardians are encouraged to ask questions such as:
- What is the plan of care for my child?
- When should we return for a follow up?
- When should I take my child to the emergency department rather than waiting for a primary care visit?
Having these conversations can help you feel prepared and supported.
Instilling Heart-Healthy Habits
Most children who are referred to a cardiologist ultimately learn that their heart is healthy. Still, these visits can be a valuable opportunity to talk about habits that support long-term health. Regular physical activity, balanced nutrition, avoiding smoking and keeping risk factors like blood pressure and diabetes in check all play an important role in maintaining a healthy heart.
By embracing these habits, both you and your child can take proactive steps to reduce the risk of future cardiac complications. A healthy heart lays the foundation for a long, active and fulfilling life.
Want to hear more from Children’s National experts? On The Lead in Peds podcast and Rise and Shine blog, pediatric leaders share the stories, science, and practical tips shaping children’s health, from major breakthroughs to everyday care.
Feature image, Nina Lawrenson/peopleimages.com/stock.adobe.com
