Chest pain remains a common complaint among children seeking care in the United States. Asthma and lower respiratory tract infections such as pneumonia can be significant causes of chest pain. Children with chest pain caused by either of these pulmonary etiologies generally present with associated respiratory symptoms, including cough, wheezing, tachypnea, respiratory distress, and/or fever. Although analgesic medications can improve chest pain associated with pulmonary pathologies, the mainstay of therapy is to treat the underling etiology; this includes bronchodilator and/or steroid medications in children with asthma and appropriate antibacterial administration in children with suspicions of bacterial pneumonia. The chest pain generally resolves along with the resolution of other respiratory symptoms.