Children Faint and When It's Serious
By Ronald J. Kanter, MD and Dennis Clements, MD, PhD, MPH
a child or teen faints, especially at school and in the presence
of peers, it is often very upsetting to other children and can be
a source of great embarrassment to the child who has fainted.
are many causes of syncope -- the medical term for fainting -- in
the young, and, happily, most do not represent a life-threatening
less common -- and far more dangerous -- conditions may first show
themselves as syncope. Because of this, children who have fainted
need to be seen by a health care professional to rule out serious
causes and to recommend therapy to limit or eliminate further fainting
(pronounced: sing-ko-pe) occurs at least once during childhood
in over 15 percent of youth, especially teenagers. Syncope is said
to have occurred when a child suddenly loses consciousness and the
ability to maintain upright posture and then spontaneously recovers.
happens when there is sudden interruption of necessary nutrients
to the brain, especially oxygen. Since oxygen is carried by the
bloodstream, any condition which causes a sudden drop in blood pressure
to the brain may therefore cause syncope.
such a circumstance sustains, sudden death may ensue (such uncommon
diseases will be discussed later in this article). Far more commonly,
sudden drops in blood pressure occur as an exaggerated reflex or
due to suddenly rising from a lying or sitting position.
the fainting youngster becomes horizontal on the ground, blood returns
to the heart and brain, and he or she quickly regains consciousness.
What causes the common faint is actually a kind of reflex
that is theoretically hard-wired into all humans, and, in fact,
many mammals. When we use the word reflex, we refer
to an automatic reaction by the body to a particular stimulus.
this instance, the automatic reaction is a sudden drop in heart
rate or blood pressure, as mentioned above. The provocative stimulus
most commonly is an exaggerated and sudden adrenalin effect on the
heart due to any of a variety of events:
pooling of the circulating blood volume while sitting or standing
for prolonged periods
Unexpected minor trauma; the sight of blood or injury (blood/injury
listening to a discussion of frightening or graphic subjects
These together are called vasovagal syncope, also known
as neurally-mediated syncope or neurocardiogenic
syncope. All three terms are synonyms.
commonly, syncope may reflexively occur during brushing of ones
hair (hair-groomers syncope), vigorous arching
of the back and extending the neck while stretching (stretch
syncope), urination (micturition syncope), and
even chewing food (deglutition syncope).
syncopes of the types described above always spontaneously terminate,
and are therefore only dangerous if they cause head trauma during
the syncopal episode.
breath-holding spells are a form of vasovagal syncope that
affect toddlers in response to sudden fright, frustration, or mild
head trauma. They are not any more serious than the teenage forms.
may have an emotional basis, including hyperventilation or syncope-like
events caused by more severe psychologic conditions (so-called conversion
reaction). These children and teens typically faint in the
presence of others and not while alone.
that occurs during physical exertion, especially when actually in
motion, may have a more serious cause and may be due to a primary
heart condition. Such events may be preceded by palpitations or
chest pain and always warrant a more complete evaluation, often
by a pediatric cardiologist
of the Child Who Faints
Among reflexive forms of syncope, your health care professional
can usually make the correct diagnosis from a description of the
event by the patient and parents.
particular, vasovagal syncope is typically preceded by a brief period
of such symptoms as dizziness, lightheadedness, nausea, changes
in vision or hearing, or a feeling of warmth.
recovery from a fainting event, children are almost always fully
oriented, but may feel weak, nauseous, or tired for minutes to hours.
syncope may even be associated with seizure activity or urinary
incontinence, although such events often warrant a more complete
evaluation by a pediatric neurologist or cardiologist.
the first fainting event, the provider will also always obtain a
family history, perform a complete physical examination, and may
perform an electrocardiogram. Vasovagal syncope often runs in families,
and certain serious heart diseases which cause syncope may also
who faint during sports participation should not be permitted to
return to strenuous activities until they have been fully evaluated
and cleared by a qualified provider. In addition to the aforementioned
evaluation, echocardiography, exercise testing, ambulatory heart
rhythm monitoring, and even cardiac catheterization may be necessary.
of the Child Who Faints
Vasovagal syncope is most commonly treated by such simple strategies
as improving daily fluid intake and reducing chronic physical or
this approach fails, evaluation by a cardiologist or neurologist
is imperative. They will likely perform an electroencephalogram
(EEG) or an electrocardiogram (ECG) and a tilt table test."
tilt table test is an out-patient procedure, during which the child
is comfortably secured to a special table capable of propping him
or her up to an almost standing posture but without the ability
to move or shift their weight. It tends to provoke vasovagal symptoms
during continuous heart rhythm and blood pressure monitoring in
those prone to vasovagal syncope, all in a safe and controlled environment.
those tests, medications may be prescribed to help minimize symptoms.
Finally, emotional causes of syncope require intervention by a mental
J. Kanter, MD, is an associate professor of pediatrics and director
of pediatric electrophysiology. His team takes care of infants,
children, teenagers, and young adults who have or potentially have
abnormal heart rhythms, pacemakers, or automatic defibrillators.
Dennis Clements, MD, PhD, MPH, is the chief medical officer of Duke
Children's Hospital. For more information, visit
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with your unique circumstances. Always seek the advice of your physician
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