Syncope
Introduction
- Is dehydrated or drinks too little water
- Skips meals
- Stands up too fast
- Stands for too long without moving around
- Is having hair brushed or combed while standing
- Becomes too hot – including from hot showers and hot tubs
- Breath-holds
- Has low red blood counts (anemia)
The temporary decrease in blood flow to the brain that causes syncope may also cause some jerking activity; this is not a seizure/epilepsy and the jerking does not respond to antiepileptic medication.
ICD-10 Coding
Pearls & Alerts
All children/adolescents with fainting episodes should have an EKG to rule out long QTc syndrome and other arrhythmias. If the EKG is normal and there are no risk factors, no further workup is needed.
Events that occur when hair is being combed, even if accompanied by jerking, are almost certainly “hair-grooming syncope” and not seizures.
Clinical Assessment
Differential Diagnoses
Medical History
- Was CPR needed after fainting?
- Did fainting occur with exercise?
- Was the faint triggered by fright or sound/noise?
- Did chest pounding or chest pain/pressure precede the faint?
- Did anyone witness posturing or jerking for 1 minute or more with the faint?
- Is there a history of an abnormal heart or neurologic examination?
- Has there been an abnormal electrocardiogram?
- Do any close family members have a history of unexplained sudden death, heart rhythm problems or cardiomyopathy, or seizures?
- Is there a history of brain or cardiac injury or disease?
- Is there any underlying metabolic or kidney disease?
- Has peripheral or autonomic neuropathy been found?
- Is there significant developmental delay?
Testing
Management
156 KB). For a more detailed explanation of this civil rights law, see 504 Plan.
Prevention
- Drink more water (urine should be clear).
- Increase salt intake.
- Eat healthy meals often enough to avoid getting too hungry.
- Avoid caffeine.
- Avoid standing in one position for a long time.
- Stand up slowly after sitting or lying down.
- Avoid getting too hot from hot tubs or standing too long in a hot shower.
- Sit when having hair brushed or combed by someone else (and get up slowly afterward).
- Boys who are prone to fainting should sit on the toilet to urinate, especially first thing in the morning.
Immediate Self-Treatment
- Lay down and raise the legs above the level of the head.
- Cross legs and squeeze the leg muscles until the lightheaded feeling goes away.
- Grip hands and try to pull them apart and down.
Subspecialist Collaboration
Refer if seizures are suspected, but keep in mind that children and adolescents often jerk with syncope, which does not need a workup by neurology,
Refer if there are abnormal items in the medical history, such as a family history of prolonged QTc syndrome or sudden unexplained death. Even though vasovagal syncope is the likely reason why some children faint while exercising, these children should still receive testing for a rare cardiac electrical or structural cause.
Resources
Information & Support
For Parents and Patients
Fainting (Nemours)
Explains the reasons that people faint and how to prevent it, how to help someone who faints, and when to see a doctor.
Practice Guidelines
Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B,
Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW.
2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of
Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
Heart Rhythm.
2017;14(8):e155-e217.
PubMed abstract
Patient Education
Lightheadedness & Fainting (Intermountain Healthcare) ( 897 KB)
A pamphlet that explains some of the causes of fainting and what to do if your child or adolescent becomes lightheaded or
faints.
Tools
Sample Letter Requesting a 504 Plan for Fainting (Medical Home Portal) ( 156 KB)
A sample of a short letter requesting that school personnel allow the child to carry a water bottle and drink from it throughout
the day, use the bathroom when necessary, and sit down or lie down if feeling faint.
Services for Patients & Families in Utah (UT)
| Service Categories | # of providers* in: | UT | NW | Other states (4) (show) | | NM | NV | OH | RI |
|---|---|---|---|---|---|---|---|---|---|
| Pediatric Cardiology | 5 | 2 | 4 | 17 | |||||
| Pediatric Neurology | 6 | 5 | 5 | 17 | |||||
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Studies
Syncope in children and adolescents (ClinicalTrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.
Helpful Articles
Wieling W, Ganzeboom KS, Saul JP.
Reflex syncope in children and adolescents.
Heart.
2004;90(9):1094-100.
PubMed abstract / Full Text
Page Bibliography
Kanjwal K, Calkins H.
Syncope in children and adolescents.
Cardiac Electrophysiology, Johns Hopkins University.
2015;33(3).
PubMed abstract