Chest Pain, Palpitations, and Fast Heartbeat in Children: When to Seek Care

An independent educational resource prepared by Mark M. Simonian, MD, FAAP

Sources checked: August 9, 2026     |     Medical review completed: August 9, 2026

This page is for general education only and does not replace individualized medical advice. This resource does not establish a doctor-patient relationship. For questions about your own child, contact your child's current healthcare professional.

Magnolia Pediatrics, Valley Children's Healthcare

2497 E. Herndon Avenue, Suite 101, Clovis, CA 93611     |     559-538-3070

Chest pain is common in children and is rarely caused by the heart. Muscle strain, coughing, asthma, reflux, and stress can all cause discomfort. However, chest pain with exertion, fainting, breathing difficulty, or a sustained racing heartbeat needs prompt evaluation.

Urgent Warning Signs - Check This First

Do not ask a child to exercise, run, or return to sports while they have chest pain, dizziness, fainting, shortness of breath, or a fast heartbeat. If symptoms are severe or the child looks ill, call 911.

CALL 911 NOW

  • Chest pain or pressure with collapse, fainting, severe dizziness, confusion, severe weakness, or inability to stay awake

  • Severe trouble breathing, blue or gray lips or face, or a child who cannot speak, walk, or drink because of breathing difficulty

  • A rapid, pounding, or irregular heartbeat together with fainting, chest pain, shortness of breath, or a child who looks very ill

  • Chest pain after a severe injury, or any situation you believe is life-threatening

GET EMERGENCY MEDICAL CARE NOW

  • Chest pain that is severe, constant, or worsening, especially with shortness of breath, sweating, vomiting, or marked weakness

  • Chest pain during or immediately after exercise, especially if accompanied by dizziness, near-fainting, palpitations, or reduced exercise ability

  • A fast or irregular heartbeat that does not settle promptly with rest, or a child who has known heart disease and new symptoms

  • Chest pain with fever and worsening breathing, or a child who is increasingly ill after a recent viral illness

CONTACT YOUR CHILD'S HEALTHCARE PROFESSIONAL TODAY

  • New, repeated, or unexplained chest pain, even when mild, if the cause is not clearly sore muscles or coughing

  • Palpitations, fluttering, skipped beats, or a racing heartbeat that recur, last more than a few minutes, or occur with activity

  • Chest pain that occurs with coughing, wheezing, fever, heartburn, anxiety, or stress and is not improving

  • Chest pain after a direct blow, especially with pain when breathing deeply, cough, or ongoing tenderness

  • Chest pain or palpitations in a child with a congenital heart condition, previous Kawasaki disease, known rhythm problem, or a close family history of unexplained early death or cardiomyopathy

Common, Often Non-Heart Causes

  • Chest-wall muscle strain or brief muscle spasm, often after sports, lifting, upper-body activity, or an awkward movement

  • Pain from frequent or forceful coughing during a cold or respiratory illness

  • Asthma or other breathing problems, which children may describe as chest tightness or pain

  • Heartburn or reflux, which may feel like burning behind the breastbone

  • Stress or anxiety, which can cause real physical symptoms but should be considered only after concerning medical causes are assessed

What to Do at Home

  • Have the child stop activity and rest. Observe breathing, color, alertness, and whether the heartbeat feels regular or unusually fast.

  • For clear muscle soreness without warning signs, use quiet rest and a warm or cool pack wrapped in cloth for comfort. Do not force stretching or activity through pain.

  • If asthma symptoms are present, follow the child's written asthma action plan. Use prescribed medicine only as directed.

  • Avoid energy drinks, caffeine pills, nicotine, vaping products, alcohol, nonprescribed medicines, and stimulant supplements. These can contribute to palpitations or rapid heartbeat.

  • Do not give another person's heart, asthma, or anxiety medicine. Seek care if symptoms are not clearly improving or you are uncertain.

When Symptoms Occur With Exercise

Chest pain, fainting, near-fainting, palpitations, or unusual shortness of breath during exercise should be evaluated before the child returns to sports. A clinician may ask about symptoms, examine the child, and decide whether tests or cardiology evaluation are needed. A normal appearance after symptoms stop does not determine safe return to play.

Call Preparation

  • What the child was doing when symptoms began, how long they lasted, and whether activity, breathing, movement, eating, or coughing changed the pain

  • Whether the child fainted, felt dizzy, had shortness of breath, fever, cough, wheeze, nausea, sweating, or color change

  • Description of the heartbeat: fast, pounding, fluttering, skipping, regular or irregular; note a phone or watch heart-rate reading only as extra information

  • Known heart, lung, or asthma conditions; medicines and supplements; and relevant family history

Related Guides

  • Wheezing and Asthma Symptoms: When to Seek Care

  • Dizziness and Fainting in Children: When to Seek Care

  • Sports Injuries in Children: When to Seek Care

  • Coughs, Colds and Breathing: When to Seek Care

Sources and Medical Review

  • HealthyChildren.org (AAP), Chest Pain in Children: Common Causes and When to Be Concerned https://www.healthychildren.org/English/health-issues/conditions/heart/Pages/Chest-Pain-in-Children.aspx

  • HealthyChildren.org (AAP), Urgent Care, ER or Pediatrician? A Parent Guide https://www.healthychildren.org/English/family-life/health-management/Pages/urgent-care-ER-or-pediatrician-a-parent-guide.aspx

  • American Heart Association, Types of Arrhythmia in Children https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/types-of-arrhythmia-in-children

  • HealthyChildren.org (AAP), Sudden Cardiac Arrest in Young People https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Sudden-Cardiac-Death.aspx