Chest pain in children and adolescents frequently involves referral to a pediatric cardiologist. The etiology of chest pain in pediatrics is broad, and the vast majority of cases are not due to underlying cardiac pathology. However, evaluations are often pursued due to fear about missing a potentially serious cardiac diagnosis, which may lead to sudden cardiac death. The management of these patients can lead to extensive investigations, medical visits, and hospitalizations, which is costly and unnecessary in many cases. This article reviews noncardiac and cardiac etiologies of chest pain, highlights pertinent details of the patient history and physical examination, discusses the evaluation of patients with chest pain, and identifies when referral to a pediatric cardiologist is recommended.