Clinical Pathways
Clinical Pathways
No reflux, worse when supine; vomiting, epigastric tenderness
No reflux, worse when supine; vomiting, epigastric tenderness

No reflux, worse when supine; vomiting, epigastric tenderness

View The Full Pathway

Decision

Musculoskeletal history, tenderness, pain on range-of-motion testing?

icon
Yes → Rest, ibuprofen, acetaminophen trial (Class II)

Background

Treatment of Musculoskeletal Conditions

Patients with chest pain due to musculoskeletal etiologies can be treated with rest and oral analgesics. The optimal doses and correct dosing intervals for these medications are critical. Ibuprofen 10 mg/kg/dose (up to a maximum of 600 mg) orally every 6 hours or acetaminophen 15 mg/kg/dose (up to a maximum of 650 mg) orally every 6 hours is recommended.128^{128} Outpatient referral for physical therapy may be necessary in a subset of these patients.16 While it is reassuring and efficient (for both patient and clinician) to identify a discrete and “easy to treat” musculoskeletal cause for a child’s pain in the ED setting, it is always wise to maintain equipoise when diagnosing conditions that have such a broad differential diagnosis, since more serious causes are sometimes lurking or occurring concomitantly.129,130^{129,130}

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References
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No musculoskeletal history, tenderness, pain on range-of-motion testing
No musculoskeletal history, tenderness, pain on range-of-motion testing
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