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Syncope in ChildrenSíncope

Syncope in Children

What is syncope?

Syncope is a brief loss of consciousness and muscle tone caused 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. This is usually because of a heart problem.

What causes syncope?

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 (or neurocardiogenic syncope). A sudden drop in blood pressure with or without a decrease in heart rate. It is caused by a problem with the nerves controlling the heart and blood vessels.
  • Arrhythmia. A heart rate that is too slow, too fast, or too irregular to keep enough blood flow to the body, including the brain.
  • 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.

Other situations or illnesses that can cause syncope include:

  • Head injury
  • Seizure
  • Stroke
  • Inner ear problems
  • Dehydration
  • Low blood sugar
  • Breath holding episodes
  • Pregnancy
  • Anemia 

What are the symptoms of syncope?

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.

How is syncope diagnosed?

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:

  • How often the syncope occurs
  • What your child was doing before the syncope
  • If your child had any symptoms before the syncope
  •  What he or she ate before the syncope

The provider will check your child's blood pressure and heart. 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 is used to evaluate irregular, fast, or slow heart rhythms while your child does his or her normal activities.
  • 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.

How is syncope treated?

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.

What are the complications of syncope?

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.

How is syncope managed?

If your child has symptoms before the syncope, his or her healthcare provider can teach you ways to help to prevent actual fainting.

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

Key points about syncope

  • Syncope is a brief loss of consciousness and muscle tone. It’s caused when the brain doesn’t get enough blood. 
  • It is usually harmless, but in a small number of children, it is 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:
  • Before your visit, write down questions you want answered.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
  • 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.