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In a prospective study of children with the primary complaint of chest pain, 43 patients were identified. This gave an occurrence (per patient visits) of 0.288%. The average age was 12.9 years for boys and 11.80 years for girls. Diagnostic categories identified were idiopathic chest pain (45%), costochondritis (22.5%), chest pain secondary to bronchitis (12.5%), miscellaneous (10%), chest pain secondary to muscle strain (5%), and chest pain secondary to trauma (5%). These six categories are discussed in terms of age, sex, resolution of symptoms, duration of the complaint, return for follow-up examination, quality of pain, psychiatric profile, and results of laboratories studies. It is concluded that chest pain in children is not as ominous a symptom as it is in adults, and that it infrequently signals underlying cardiac disease or other serious disease that is not apparent from a thorough history and physical examination.