The chest pain in pediatrics represents a low percentage of the total of consultations, nevertheless it generates a high concern both in the parents and in the health team. In general, it is a benign process and the cardiac etiology is infrequent, reaching only 1-4%. In the present update work, the different etiologies are reviewed, in order to identify factors that guide the cardiac etiology and thus refer to the specialist or hospitalize in a timely manner if required.