Dear Doctor Samson,
“My 14-year-old son has been getting chest pains over the past several months. The pains come on at any time, sometimes while watching TV, eating dinner or playing hard. They last a few seconds, then go as quickly as they come. While the pain is present, it hurts more when he takes a deep breath. It seems to be located along the border of the breastbone, close to where the heart is. Is this a sign of heart disease? Chest pain in a male of any age always worries me.”
When doing teen-age physicals, I am frequently asked this question. As you indicated above, chest pain is always a fearful situation. In this circumstance, however, it is an annoyance, not a concern.
Between ages 10 and 20 years, this is an extremely common problem. Males are involved much more frequently than females. The pain may present itself at any time. It can be very sharp, increase with a deep breath, does not radiate to shoulder or arm, and leaves in a matter of five to 15 seconds.
Some individuals forcefully take a deep breath to make it leave, even though the maneuver causes the pain to momentarily increase. As you observed, it certainly is not related to exertion. In fact, it frequently occurs at a time of inactivity.
One must keep in mind that it is more frightening to the adolescent having the pain than to the parent who observes it. Yet, because of the adolescent temperament, he or she will worry in silence and not share his or her concern until the worry builds to a fever pitch.
Usually the patient has been concerned for months before he will ask your opinion of the pain. It is for this reason that I usually bring up the subject while doing routine physical exams in this age group.
I am usually asked, "Why does the pain occur?" There are several theories but I feel it is due to microscopic movement of the attachment of the rib cartilage and sternum (breastbone).
Up to age 18 to 20 years, this junction is not as solid as it will be beyond this age. This minute amount of movement obviously activates pain nerve endings, provoking the discomfort. The normal rib cage movement, in a few seconds, restores the proper alignment and the pain ends.
The theory of why it occurs is less important than the fact that this pain phenomenon is an acceptable occurrence in the adolescent age group in either male or female, and not a harbinger of future heart disease.
We must keep one thing in mind: chest pain that lasts longer than several seconds, that is brought on by exertion, that radiates to the shoulder or arm, and that is not made worse by a deep breath may be a sign of a heart problem. If any question exists in your mind, discuss the problem with your physician.
So often, as parents, we forget teenagers have many concerns about their changing bodies. Frequently they are too embarrassed or frightened to bring up the subject to us. Therefore, they worry needlessly about such things. We can help them by making them aware of concerns that are not serious, such as this type of chest pain.
The key phrase is "make them aware". Don't question them--inform them. So often our attempts to inform them really is interrogation. If you keep this in mind your ability to communicate, and thus help them, will be greatly enhanced.