Pediatric Costochondritis Treatment & Management

Updated: Aug 20, 2018
  • Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Lawrence K Jung, MD  more...
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Treatment

Medical Care

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  • Reassure patients diagnosed with costochondritis that the cause of their chest pain is neither cardiac nor malignant in origin.

  • Treatment involves conservative local care with judicious use of nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics, as necessary. Cough suppressants may be beneficial if cough is an aggravating factor. Stretching exercises have also been suggested and demonstrated to be of some benefit for the resolution of costochondritis. [21]

  • Liberal use of ice is recommended for 20-minute intervals.

  • Advise relative rest for the patient's upper extremities and avoidance of possible precipitating or exacerbating activities.

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Consultations

Occasional refractory cases may require consultation with the following specialists:

  • Primary care sports medicine physician [22]

  • Rheumatologist

At any time that there is a concern for an alternate or more serious diagnosis, consultation with the appropriate medical specialist would be prudent. Selbst described the conditions for which to refer pediatric and adolescent patients with chest pain according to the following findings or diagnoses: [23]

  • Acute distress

  • Significant trauma

  • History of heart disease or related serious medical problem

  • Chest pain with exercise, syncope, palpitations, dizziness

  • Serious emotional disturbance

  • Esophageal foreign body, caustic ingestion

  • Pneumothorax, pleural effusion

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Activity

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  • Activity restrictions include relative rest. Instruct the patient to avoid activities that exacerbate symptoms. Collision or contact sports may be limited until the patient can perform activity-specific movements without pain.

  • Applying ice after activity usually helps alleviate a significant amount of pain or discomfort.

  • Resumption of aggravating activities prior to resolution may cause relapse.

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