TableĀ 3

Chest painā€”indications for further action

CXRAcute onset of severe pain
Pain awakening from sleep
History of drooling, foreign body ingestion
History/signs of significant trauma
Abnormal pulmonary/cardiac auscultation
Trial anti-reflux medication/pH/impedance monitoringGastrointestinal-type pain (see text)
Epigastric tenderness
ECGCardiac-type chest pain (see text)
Further resources on interpretation of the paediatric ECG are available elsewhere17 18Cardiac red flags (see box 1)
Pericarditic pain (see text)
Any abnormal chest sensation/pain in a preschool child
Abnormal cardiac auscultation or diminished pulses
Abnormal heart rate or rhythm
Family history of sudden death, inherited arrhythmias, cardiomyopathy or ICD/pacemaker insertion
Referral to paediatric cardiologyCardiac-type chest pain (particularly exertional)
Abnormal ECG
Potentially inherited cardiac disease
Abnormal cardiovascular examination
Exercise-induced syncope or dizziness
Palpitations or cyanosis
  • CXR, chest radiograph; ICD, implantable cardioverter defibrillators.