12 year old chest pain during exercise

[AnnonymousMum]

DS has been going to athletics training every weekend for 3 years. Over the last few months he's been struggling to keep up and gets really out of breath. He's been complaining of lower chest pain on both sides, around his bottom ribs.

We went to the GP and she listened to his chest and measured his breath output thingy but no concerns. She gave him an inhaler to trial but he tried it out today and still really struggled. He does think it helped a bit, but it's awful to see him working so hard but getting lapped by much younger kids and struggling to get his breath. He left early today because he was so drained.

I would have thought he'd be quite fit. As well as this training he also swims 2 hours a week, walks to school and plays football in the playground etc.

I'm worried we're missing something. Is it normal when pushing himself? Does he just need to exercise more to build tolerance and fitness? I worry he'll hurt himself or that there's an underlying issue but he says I'm overreacting.

We're going back to the GP for a review in a couple of weeks but has anyone else experienced this ?

Thanks.

My first thought would be asthma, too. Has your GP given you a peak flow meter, to keep track of whether his peak flow drops when he feels out of breath? I'm assuming it's a blue (salbutamol) inhaler you've been given? Was he advised to try it before he started exercise, or after he got short of breath? How many puffs?

Has the GP ruled out heart conditions? DN developed these symptoms suddenly overnight and it was a heart infection.

Thank you for replying. She hasn't given us a meter, she just tested him at rest in the appointment. And yes a blue inhaler with a spacer. 2 puffs before exercise and he had another 2 when struggling today. He said after the 2nd dose he felt like he was able to run more easily whereas before he couldn't keep up but it didn't last and he was still struggling by the end and left early.

GP said it could be exercise induced asthma/bronchospasm as no concerns at rest.

She listened to his heart and took his blood pressure. Would that show that up? His blood pressure was 'on the low side of normal' but she said she wasn't concerned. He has also nearly fainted at school once a few weeks ago out of the blue but she said unless it happened again she wouldn't be worried. I can't help but worry!

I think I'd ask for an ecg as my first thought was cardiac related as well, occasionally heart issues aren't picked up until adolescence.

You need to ask for an ecg.

It does sound like asthma to me though, it often needs a stronger inhaler than they initially give you. Cough variant asthma is silent and the most common symptom is chest pain.

It sounds like it could be asthma so continuing with the inhaler would be a good thing. He won’t necessarily notice a difference straight away as I remember it took me a couple of weeks to improve.

I have heart disease, some things can be heard when listening to the heart but a lot of things can easily be missed if a gp doesn’t know what they are looking for! I would be pushing for an ecg to just rule out any heart conditions as it could be congenital and only starting to show now.

Sounds like exercise-induced asthma, but I would expect GP to request an ECG to rule out cardiac causes, too.

My son has the same and it happens to him if he eats and walks at the same time (for instance, when we travel and we grab a sandwich, we always need to stop until the pain goes away). A pharmacist mentioned GERD/reflux as a possibility and he gave us some pills to try and bingo! Sometimes exercise triggers acid, especially if he drinks in between.

About the heart, I have a heart condition that causes benign arrhythmia and it can be painful (like a stabbing) when I walk very fast. This heart condition can only be detected by doing a heart ultrasound, so maybe it's a good idea to ask for that. There are so many benign conditions that show up later in life (mine when I was 12 like him).

He may need an ECG and possibly an exercise stress test.
ECG's are good but often cardiac problems (arrhythmias) can mask themselves when the heart is at a resting pace.

when you have an exercise stress test, they hook you up to an ECG, blood pressure monitor & oxygen monitor on your finger and then you go on a treadmill from a slow walking pace to a mid jog, this way they can see how your heart and lungs react to exercise (stress placed on the heart).

They do this often in Switzerland, but I'm not sure about the protocol in UK.

The reason I know this is because I would have palpitations when running, I was diagnosed with an arryrhmia following stress test when I was 15. I've taken a beta blocker ever since and have had no problems since.

The cardiologist did tell me if the stress test showed nothing they would consider implanting a tiny loop recorder in my chest that could record any arryrhmia over the length of 3 years.