What causes chest pain in children and adolescents?

​Chest pain can be from cardiac or non-cardiac causes.
 
Cardiac chest pains could be related to infection of heart muscle (myocarditis) or the covering of the heart (pericarditis). This is often preceded by fever, malaise, fatigue, loss of appetite following a tummy bug. Rarely, this can worsen rapidly causing a heart attack. Other causes of cardiac chest pain are from congenital abnormalities of coronary arteries, the blood vessels supplying the heart muscle with oxygen. Although rare, they can cause sudden collapse during or soon after strenuous exertion related to exercise or sports. Heart muscle disease due to various causes can present with chest pain from insufficient blood and oxygen supply to the muscle. Any chest pain associated with exercise, palpitations or fainting (syncope) is likely to suggest an underlying cardiac cause and needs to be investigated urgently.
 
Non cardiac causes are most likely from chest wall structures and are called musculoskeletal pains. These generally are described as sharp or stabbing and could occur for a few seconds to minutes multiple times and often come during rest or simple activities. The pain worsens with deep breathing, coughing, laughing or unusual postures and can get worse by pressing upon those points on the chest. The pain responds well to common pain-killers such as paracetamol or anti-inflammatory medications like Ibuprofen. Lung infection can cause severe chesty cough and chest pain. Gastro oesophageal reflux  or heart burn  is common in adolescents and associated with stress and anxiety.