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Chest wall pain was the most common diagnosis in the group A (64%). Other causes included pulmonary (13%), psychological (9%), cardiac (5%), traumatic (5%), and gastrointestinal problems (4%). The organic causes were easily identified or suspected by history and physical examination. Chest radiography, electrocardiography, and blood analysis were performed in most patients with suspected nonorganic chest pain but in no case were organic diseases diagnosed by those ancillary studies. In group B, chest wall pain was also the most common diagnosis (89%). Supraventricular tachyarrhythmia and exercise-induced asthma were demonstrated in 5 (7%) and 3 patients (4%), respectively. The most important tools in assessing a child with acute chest pain in an emergency department are thorough history and physical examination. Assessment of recurrent chest pain is more difficult; arrhythmia, and allergic and exercise-induced asthma may be underestimated when investigations are not performed.

Our aim was to underline possible differences in heart rate and rhythm patterns between ambulatory and hospitalized children. Holter monitoring was performed on 264 healthy ambulatory children and on 112 children who were hospitalized for noncardiotoxic conditions. Maximal, mean and minimal heart rates decreased with age. Maximal heart rate was significantly higher in ambulatory schoolchildren and adolescents than in hospitalized ones. Sinus arrhythmia was noted on every recording. Some children had episodes of first- or second-degree atrioventricular block while sleeping. Supraventricular and uniform ventricular extrasystoles were common. The incidence of all types of arrhythmia and conduction disturbances was similar in ambulatory and hospitalized children. These data can be taken as a basis for the analysis of 24-hour electrocardiogram monitoring in ambulatory but also in hospitalized children.

Health benefits of a physically active lifestyle are well documented. We therefore investigated the physical activity patterns of 200 children from Liège. They were monitored continuously using a 24-hour Holter monitoring system during normal weekdays and the percentage of heart rate reserve (%HRR) was used to measure the amounts of physical activity at different intensities. Preschool children attained 184.3+/-54.2, 40.7+/-16.1, 15.8+/-6.9 and 6.0+/-7.2 minutes/day (mean+/-SD) between 20% to 40%, 40% to 50%, 50% to 60%, and greater than 60% of HRR, respectively. At the same %HRR intensities, schoolchildren attained 165.6+/-74.6, 32.1+/-12.1, 15.8+/-6.7 and 7.0+/-5.9 minutes/day, and teenagers attained 159.2+/-68.3, 32.1+/-23.5, 13.1+/-6.0 and 6.1+/-6.3 minutes/day. Age was a significant predictor of the intercept and slope of the time spent in physical activity and %HRR relationship. In Liège the average youth accumulates +/-30 to 40 minutes/day of moderate-intensity physical activity and +/-20 minutes/day of high-intensity physical activity. Those children meet the classical revised guidelines for physical activity but do not compare favourably with children from elsewhere. On the other hand, they get more than 2 1/2 to 3 hours/day of low-intensity physical activity. Our findings suggest that children from Liège are not engaged in sedentary behaviour but do not experience the ideal amount and type of physical activity classically believed to benefit the cardiopulmonary system. Public health strategies should be adapted to our findings.

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