Chest pain is a common presenting complaint in children and adolescents that often causes significant anxiety for both the patient and their families. Unlike in adults, the majority of chest pain in pediatrics is noncardiac in nature. The following article outlines the important elements of the history and physical, as well as ancillary tests, that can help differentiate between the noncardiac causes of chest pain. It also highlights high-risk features concerning for cardiac causes of chest pain that require further evaluation by a pediatric cardiologist. The most common cardiac causes of chest pain are discussed, as well as the initial management and treatment for the general pediatric provider.