Doc, My Kid’s Heart Is Beating Out His Chest!

This week’s guest columnist is Dr. Danielle Duhon, a family practice resident at the University Hospital and Clinics here in Lafayette.

First the child complains of chest pain.  She might even say it in scarier terms: “My heart hurts.”  Then mom puts a hand on daughter’s chest- mom can feel her heart beating!   Maybe Uncle Joe just died of heart disease.  Now it’s panic time!

Chest pain and palpitations are scary things.  Adults think about heart problems and assume the worst.  After all, we have been told over and over: if you have chest pain, get seen, it could be a heart attack.  In kids however, chest pain is rarely the heart- it’s usually strains in the chest wall- ribs, cartilege, and muscle. Sometimes it’s heart burn or occasionally lung issues.

But what about palpitations- that feeling of heart pounding?  Your child complains, you feel their chest, and you’re certain the heart is going to jump right out!  Before you lose your cool, try to think.  Lots of things can cause your child’s heart to race: recent activity, caffeine, or many medicines.  If your child has been running around or doing other high-energy exercise, have them rest for a moment.  See if it slows down.

Consider other causes of a pounding heart.  Caffeine can ramp up your child’s heart rate. Soda, coffee, and especially energy drinks all contain caffeine and other stimulants. The extra ingredients that give energy drinks their “boost,” like guanara, can be more stimulating than caffeine and make the heart race like crazy.  Now there are “energy” candies, gum, gels, and water mix-ins.  With all that stimulant coursing through your veins, it’s no wonder your heart is going BA-DUM, BA-DUM!

There are several medications that can push the heart. Even if your kid is adult-sized, children metabolize medications differently than adults. Always read the bottle or talk to your doctor to make sure the medication and dose are safe.  Examples of medications that can stimulate the heart include antihistamines (benadryl, chlorpheniramine, hydroxyzine, zyrtec, claritin, allegra), decongestants (pseudophedrine, phenylephrine), and cough suppressants (dextromethorphan).

Besides caffeine and over-the-counter medications, your child could be prescribed a medication that can cause palpitations.  These include stimulants to treat ADHD or inhalers for asthma.  If a kid combines those medications with other stimulating medications or caffeinated drinks, he is getting double duty and can certainly have a pounding heart.

Unfortunately some teenagers smoke cigarettes (real or electronic) or use chewing tobacco.  These contain nicotine, which is a stimulant.  Used alone or in combination with medications, caffeinated or “energy” drinks, and/or prescriptions, nicotine will certainly get some teenagers’ hearts going overtime.

Finally, anxiety is a common cause of palpitations.  Some kids are worriers.  Kids have lots to worry about.  There is pressure to do well in school.  There can be family strife like parental fighting and divorce, bullying siblings, or loss of a loved one through moving or death.  There are social worries: am I too fat/ugly/stupid/boring/etc? Some kids also worry about the big questions: Will the world end?  What is the meaning of life?  Does the little red-haired girl like me?

Some kids live with worry so much they internalize it and don’t realize that worries are the cause of their pounding heart.  Sometimes we ask the child what is worrying them and they can’t say because they are so used to the worry that they don’t realize it IS a worry. Or they are afraid to talk about it in front of a parent.  This is where counseling can be helpful so the child can explore and diffuse the anxiety.

Now don’t hesitate to call your doctor if your child is having a pounding heart with dizziness, fainting spells, or breathlessness.  There are medical conditions that need be checked.  If you can’t talk to your doctor and are concerned, you can go to the Emergency Department. But perhaps you can think back and figure it out before you get to that point. Kids have strong hearts, so strong that even though it’s probably not a heart problem, it feels like its going to beat right out of his chest!



Chest Pain! Is My Child Having a Heart Attack?

Kids and teens will sometimes have chest pain.  It happens more often than you think.  We see at least 4-5 kids per week in the Emergency Department for complaints of chest pain.  When it happens, parents sometimes freak out.  Is it a heart attack, like happened to Uncle Frim?  Even worse, some kids will even say “My heart hurts” when they mean ”chest pain.”  Talk about causing a freak-out!

Teenagers have chest pain the most.  As they grow, they often have aches and sharp pains in their rib cages.  Teens worry about that more because they are already worried about what is happening in their developing bodies- new shapes and sizes, new emotions, and new aches and pains. 

Here is the good news: chest pain in kids is rarely a heart problem.  Lung problems are unusual too.  The vast majority of aches and pains in the chest are in the chest wall, the ribs and ligaments and cartilage that form the rib cage.  When kids exert their chest wall with coughing or exercising or injury, those parts of the rib cage get sore, just like any other injury.  Sometimes in teenagers a “hot spot” in the chest wall just seems to happen out of the blue.

When should you really worry?  The warning signs for lung problems are more obvious: coughing and shortness of breath, fever and fatigue.  Heart problems in kids are rare, and usually don’t cause sudden pain, like in adults.  Heart issues tend to start with progressive weakness, shortness of breath, changes in weight (weight loss or weight gain).  We also pay attention to kids who faint or have deep chest pain when they exercise.  Those kids need to get seen right away.  Finally, some kids have a history of family members who died suddenly at an early age (younger than 40).  Those families can have a rare inherited problem with cardiac rhythm, and the kids in the family can have it. 

However, if your teen complains of sharp chest pain that is worse when you press on the pain site, hurts more with a deep breath (stretching that hot spot), but is otherwise awake and alert and well and active, don’t panic.  Treat with plenty of ibuprofen, cut back the exercise and stress to let things heal, and it should be gone in about four days.  The vast majority of teens and kids have good hearts.  In more ways than one!