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Syncope in Children
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What is syncope in children?

Syncope is a brief loss of consciousness and
muscle tone (or posture) that can occur when
not enough blood gets to the brain. Syncope is
commonly called fainting. In most children, it’s
usually harmless. But in a few children,
syncope is serious. Fainting may be due to a
heart problem, or sometimes a neurological
problem.

What causes syncope in a

child?
The common reason behind each fainting
episode is a temporary lack of oxygen-rich
(red) blood getting to the brain. However,
many different problems can cause a
decrease in blood flow to the brain. Some
causes of syncope include:

Vasovagal syndrome
(neurocardiogenic syncope). A sudden
drop in blood pressure with or without a
decrease in heart rate. It's caused by a
problem with over stimulating the nerves
that have direct input on the heart and
blood vessels. This is the most common
cause of syncope and can follow periods
of extreme emotion. It's generally a
benign condition.

Heart rhythm problem (arrhythmia). A

heart rate that is too slow, too fast, or too
irregular to keep enough blood flow to the
body, including the brain. This is a fairly
rare cause of syncope, especially in
children.

Structural heart disease (muscle or

valve defects). There may be problems
with the heart muscle or one or more of
the heart valves. This may cause a
decrease of blood flow to the body,
including the brain. Inflammation of the
heart muscle known as myocarditis can
also cause fainting. The heart muscle
becomes weak and is not able to pump
as well as normal. The body again reacts
to decreased blood flow to the brain by
fainting.

Orthostatic hypotension. This is a drop

in blood pressure that occurs when a
person has been standing for a while, or
changes from a sitting to a standing
position. Blood pools in the legs,
preventing a normal amount of blood
from being pumped to the brain. This
brief drop in blood flow to the brain
causes a person to faint. This more
commonly occurs in older adults.

Other situations or illnesses that can cause

syncope or mimic syncope include:

Head injury

Seizure

Stroke

Inner ear problems

Dehydration

Low blood sugar

Breath holding episodes (Typically in

children 6 month to 2 years of age)

Pregnancy

Anemia

Brain mass

Aneurysm or abnormality of the blood

vessels of the brain

Urination

Having a bowel movement

Coughing

Certain symptoms that occur with syncope

may suggest a more serious problem. These
include:

Syncope occurring during exercise or

strenuous physical exertion

Syncope which is accompanied by

palpitations or a sensation of rapid
heartbeats

If you have syncope and you have a

family history of sudden cardiac death

What are the symptoms of

syncope in a child?
Some children will have symptoms before they
faint. A child may have:

Dizziness

Lightheadedness

Nausea

Changes in his or her vision

Cold, damp skin

There may be enough warning signs that your

child will have time to sit or lie down before
fainting occurs. This can prevent injuries that
may happen because of falling during
syncope, such as head injury.

How is syncope diagnosed in

a child?
The healthcare provider will ask about your
child’s symptoms and health history. He or she
will give your child a physical exam. Helpful
details you can provide include answers to
these questions:

How often does syncope occur?

What your child was doing before the

syncope?

Did your child have any symptoms before

the syncope?

What did he or she eat before the

syncope?

What happened during and after the

syncope? Was there any loss of bowel or
bladder control?

Was the syncope witnessed?

How long did the period of loss of

conscious persist after syncope?

The provider will check your child's blood

pressure and heart rate. Your child’s blood
pressure is usually checked more than once in
different positions. It may be taken while your
child is lying down, sitting, and standing. The
provider will look for changes in blood
pressure that occur with orthostatic
hypotension.

Often your child will not need any tests. If your

child's provider thinks there may be a serious
problem, he or she may refer you to
a pediatric cardiologist. This is a doctor with
special training to treat heart problems in
children. He or she may order tests, such as:

Electrocardiogram (ECG). This test

records the electrical activity of the heart.
It shows any abnormal rhythms
(arrhythmias).

Tilt table test. This test checks a child's

blood pressure and heart rate while he or
she is in different positions.

Holter monitor. This test uses a portable

monitor that your child wears for 24 hours
or longer. It's used to evaluate irregular,
fast, or slow heart rhythms while your
child does his or her normal activities,
even while away from the provider's
office.

Echocardiogram (echo). This test

studies the heart's function. It uses sound
waves (ultrasound) to make a moving
picture of the heart and heart valves,
pumping function, and blood flow through
the heart.

How is syncope treated in a

child?
After an episode of syncope, your child should
lie down for 10 to 15 minutes. Or, your child
can sit with his or her head between the
knees. Give your child a drink of water.

Work with your child's healthcare provider to

figure out the cause and ways to prevent
further syncope.

If a heart problem is the cause of syncope, the

pediatric cardiologist will figure out what
treatment is needed. Occasionally, the
problem can also be due to a brain problem
and may require consultation with a pediatric
neurologist.

What are possible

complications of syncope in a
child?
Most syncope in children is harmless. In a
small number of children, serious heart
problems may be the cause of syncope.
Sudden death can occur.

What can I do to prevent my

child from passing out?
To prevent passing out caused by
dehydration:

Be sure your child stays well hydrated.

Encourage him or her to drink plenty of
water.

Increase salt intake. Try non-fat salty

snacks such as pretzels or crackers.

If passing occurs when standing too long:

Advise your child not to lock his or her

knees when standing.

Advise your child to promote blood flow

by relaxing and tightening the leg
muscles.

If your child has passed out upon standing:

Make sure your child sits up slowly, lets

his or her legs hang off the bed, and tell
him or her to wiggle the toes and take a
few deep breaths before standing up.

If your child feels like he or she may pass out,

advise him or her to sit or lie down quickly.

When should I call my child's

healthcare provider?
Call your child's provider if he or she has
syncope, especially if:

It continues even with preventive efforts

It occurs with irregular heartbeats

It occurs with exercise

You have a family history of syncope

There is no known cause

It occurs unpredictably and in dangerous

situations

Injuries occur afterwards

Key points about syncope in

children
Syncope is a brief loss of consciousness
and muscle tone. It’s caused when the
brain doesn’t get enough blood.

It's usually harmless, but in a small

number of children, it's caused by a heart
problem.

Syncope is usually diagnosed with a

health history and physical exam,
including checking blood pressure and
heart rate.

If there is no serious cause, syncope is

managed by finding the cause and
learning ways to prevent it.

Next steps
Tips to help you get the most from a visit to
your child’s healthcare provider:

Know the reason for the visit and what

you want to happen.

Before your visit, write down questions

you want answered.

At the visit, write down the name of a

new diagnosis, and any new medicines,
treatments, or tests. Also write down any
new instructions your provider gives you
for your child.

Know why a new medicine or treatment

is prescribed and how it will help your
child. Also know what the side effects
are.

Ask if your child’s condition can be

treated in other ways.

Know why a test or procedure is

recommended and what the results could
mean.

Know what to expect if your child does

not take the medicine or have the test or
procedure.

If your child has a follow-up appointment,

write down the date, time, and purpose
for that visit.

Know how you can contact your child’s

provider after office hours. This is
important if your child becomes ill and
you have questions or need advice.

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