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8 year old with sharp chest pain... Dr. says go see a Psychiatrist
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8 year old with sharp chest pain... Dr. says go see a Psychiatrist

My 8 year old son has been having sharp chest pains for about 2 years. We had brought him into the hospital and they ran several tests (ekg...) all came back negative.  They wanted to monitor him, but we ended up having to move (military).  Just recently the pains are occuring more frequently so we brough him into our new hospital. THey did an EKG (negative). The Dr. ask lots of questions (eating, exercising..) and decided that the pain was imaginary and that we (parents) were feeding into this every time we showed concern about the pain.  I told him that I have the same pains so I believe him. He then responded with... So tell me what you want me to do.   He never looked at my son or listened to his heart. I am now looking for a Dr. off base but would like to have some idea as to what to ask the Dr. and what could be wrong.

He is 53" and 55 pounds.  very pale and has dark circles under his eyes.  He isn't much for running around and prefers less aerobic activities.  He has a bowed chest in the middle which is where he complains of the pain.  When he complains if you put your hand on the center of his chest you can feel his heart beat.

Maternal grandfather died at 41 of a heart attack.  During the autopsy they found he had Mitral Valve Prolapse which 20+ years in the military was not detected.  Could this be what is causing the pain in my son?
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773637_tn?1327450515
Dear Paula,

Although pain can be seen in some patients as a conversion disorder, in which it is more of a psychiatric cause, sharp chest pain is frequently seen in adolescents, and can be seen in some younger children, as well.  Of note, the heart is the least likely cause of chest pain in the pediatric and adolescent population.  I don’t have enough information to say for sure if your son’s chest pain is benign, or not.  However, if it is brief, sharp, usually hurts worse with breathing in, and spontaneously resolves, it is likely to be typical chest wall pain.  It has no known cause, but we know that it is benign.  His height and weight appear to be appropriate for his age and gender.  The pallor and dark circles may be associated with inadequate sleep or with chronic allergies, so you may want to look into this more.  Unfortunately, many emergency department physicians who do not typically treat pediatric patients are not used to managing pediatric chest pain.  Overall, your primary care provider should be able to assess whether this is benign, or not.  If you are not able to get a reasonable answer for this, then consider a pediatric cardiology evaluation.

Finally, mitral valve prolapse does not cause chest pain unless there is significant mitral valve regurgitation associated with it that is also causing decreased cardiac pump function.
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773637_tn?1327450515
One more thing to consider:  his "bowed" chest may be what's called a pectus excavatum, or scooped-out chest.  Although by itself it does not typically cause any problems, it can be part of certain connective tissue disorders, genetic syndromes that can have several different connected findings.  Mitral valve prolapse can be another one.  It may be worthwhile in your son's case to have him seen by a pediatric cardiologist anyway, and raise the question of connective tissue disorders during the evaluation.
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773637_tn?1327450515
Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
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