1. The pain is "crushing" or pressing down.
2. There are other symptoms like passing out, nausea or skipping/racing heartbeats.
3. The pain is brought on by exercise.
4. There is a medical history that would worry you (examples are a history of heart disease, Kawasaki disease or Marfan syndrome).
5. There is a history of a murmur. 

And here are 5 other common causes of chest pain:

1. Muscular or chest wall pain. The pain comes back when you touch their ribs or chest.
2. Reflux. The pain is after meals or described as burning.
3. Anxiety. The pain is associated with stressful situations.
4. Lungs. The pain is associated with a deep breath or there is a history of asthma.
5. Who knows? It's fairly common that we can't figure out where it came from but this should only be said after everything else has been considered or checked for.

We have been trained to assume that chest pain is caused by the heart and an emergency, which is right in adults. But, one of the basic principles of pediatrics is that children are not “just little adults.”

Chest pain is a perfect example.

What are some common causes of chest pain in children?

1. Muscular or rib pain - This is the most common cause of chest pain in children. Pain can be caused by a bruise, muscle strain or after repetitive coughing.

2. Lungs - Asthma and pneumonia are two common lung causes of chest pain.

3. Stomach - Reflux can cause chest pain (think “heartburn”).

4. Psychological - Stress, anxiety and panic attacks frequently show up as chest pain.

If most chest pain in children is not an emergency, when does it become one?

1. The pain is severe, especially if it has the classic findings of heart pain (crushing pain, under the breastbone, moving to the left arm or up the jaw).

2. The pain is associated with difficulty breathing.

3. The pain has is associated with other symptoms (fever, nausea/vomiting for example).

What are some other findings that suggest the heart is the cause of chest pain?

1. The pain is associated with exercise or limits the child’s ability to exercise.

2. The child has lightheadedness, dizziness or faints with exercise.

3. There is a family history of heart problems or sudden death, especially if early in life.

If your child has any chest pain, a visit to your doctor is important so that they can ask you questions and perform an exam on your child to determine the cause and right treatment.