Chest pain in the pediatric population is a common and mostly benign occurrence. A thorough history and physical examination are usually all that are necessary in excluding the rare, life-threatening causes of chest pain. These rare, life-threatening events require immediate evaluation, treatment, and subspecialty consultation. Idiopathic chest pain is the most common diagnosis, and the symptoms are typically chronic. laboratory testing is usually nondiagnostic, costly, and burdensome to patients and therefore unnecessary. A long-term, trusting relationship with the patients and their families is needed to reassure them and allow symptoms to resolve.