Objective To examine differences in factors related to health care utilization (HCU) among children eventually diagnosed with noncardiac chest pain (NCCP) or an innocent heart murmur (IHM). Methods 67 pediatric patients with NCCP and 62 with IHM and their parent/guardian completed paper-and-pencil measures of psychological functioning and past HCU during an initial visit to the cardiologist’s office. Results Children with NCCP utilized significantly more health care services compared to their IHM counterparts in the year prior to their cardiology visit. Children in the NCCP group had higher internalizing and somatic symptoms, and their parents experienced more anxious symptoms, than those in the IHM group. For the NCCP group only, child and parent psychological symptoms and parent HCU were positively related to child HCU. Conclusions Results identify possible child and parent psychological factors that may be the focus of interventions to reduce high rates of HCU among children with NCCP.