Fainting,or loss of consciousness, is never normal in a child and should always be evaluated by a physician.  The most common causes of fainting in children are benign, non-heart related events.  However, some types of fainting may represent serious or life-threatening medical problems.  There are three major classes of fainting: vasovagal, cardiac, and noncardiac.  The medical term for fainting is syncope.  Syncope is defined as a temporary loss of consciousness, and muscle tone that is typically associated with a rapid recovery.  Syncope, or near syncope, is extremely common in older children.  Up to 50% of college undergraduates report having had syncope or near syncope.  Syncope in children younger than five years of age, is much less common.  The evaluation for the cause of syncope may be extensive or simple reassurance.  It is up to your doctor to decide how aggressive the evaluation should be.

What is fainting (syncope)?

Fainting is a temporary loss of consciousness and muscle time often associated with a rapid recovery.  Most causes of fainting are benign because no long-term problems.

What is near-syncope?

Near-syncope is the medical term used to describe an event where there is only partial loss of consciousness and/or muscle tone.  The causes of near-syncope may be similar to those of syncope, but with milder symptoms.

Who is affected by fainting?

children of all ages may have fainting episodes.  The age of the child helps your physician determine the cause.  For children less than five years of age, painting may represent a breath holding spell.  This occurs when a very upset child, in the middle of a crying episode, breathes out in extreme frustration and pauses and a usual amount of time before breathing in.  This may cause the child to rarely lose consciousness.  The most common age group for painting in children is 10 to 12 years of age.  Females are affected more commonly in males.

What are the symptoms of fainting?

In most cases there is a prodrome of symptoms.  This means that there are several symptoms before the actual fainting episode occurs, such as:

• light-headedness
• blurring of the vision
• nausea
• sweating
• weakness

Some special types of painting may be preceded by particular events,such as:

• standing up quickly
• standing too long, especially with the knees locked
• combing, brushing, or blow drying the hair
• urinating
• an emotional outburst in a toddler (breath-holding spell)
• a feeling of extreme emotion
• the sight of blood or an injury

What causes fainting?

Vasovagal

Vasovagal syncope is the most common cause of fainting in children, accounting for up to 80% of cases.  This type of thinking is caused by changes in the autonomic nervous system, the system, which controls heart rate and blood pressure.  The autonomic nervous system is affected by changes in position, bodily functions, pain, fear, or other strong emotional events.  In this type of fainting, there may be an inappropriate change in heart rate and blood pressure that deprives the brain of adequate blood flow and oxygen.  This leads to loss of muscle tone and consciousness causing the body to fall to the ground.  While the body is lying down, it is much easier for the heart to pump blood to the brain.

Some specific causes include:

• standing up quickly
• standing too long, especially with the knees locked
• combing, brushing, or blow drying the hair
• urinating
• an emotional outburst in a toddler (breath-holding spell)
• a feeling of extreme emotion
• the sight of blood or an injury

Cardiac

Cardiac causes of syncope are related to the heart.  Cardiac syncope is very uncommon in children, but may represent a serious or life-threatening event.

some specific causes include:

• tachyarrhythmias (rapid heartbeat problems)
• bradyarrhythmias (slow heart rate problems)
• left or right ventricular outflow tract obstruction (blockage of blood flow through the vessels away from the heart)
• pulmonary hypertension (a rare occurrence in newborns caused by high blood pressure in the lungs)
• coronary artery disease (extremely rare in children, either a congenital problem or due to vascular damage from Kawasaki disease)
• primary heart dysfunction (due to problems with the muscle of the heart)
• secondary heart dysfunction (damage to the heart muscle by a virus, bacteria, or injury)

Non-cardiac

• orthostatic hypotension (standing up to quickly close parentheses.
• neurologic (seizures, atypical migraine, dysautonomia)
• breath holding spells.
• Psychogenic ( hyperventilation, anxiety, or hysteria.)
• A metabolic abnormality (low blood sugar or any).
• A drug or medication affect

What diagnoses are associated with syncope or fainting?

The potential causes are too long to list.  Basically, any condition that creates the symptoms described above can cause syncope or fainting.

When should I worry about fainting?

Any cause of fainting or syncope in children should be discussed with your doctor.  You should seek medical care immediately if any of the following occur:

• unexplained, sudden fainting
• cyanosis (blue coloration of the lips or skin)
• prolonged loss of consciousness
• fainting during exercise or activity
• apparently breathing difficulty
• fainting after an injury

How is fainting evaluated?

History

Your physician will ask all questions such as:

• What was the child doing before the event occurred?
• Were there any symptoms before the fainting occurred?
• Was your child sick, dehydrated, or fatigued before the event?
• Did your child feel any chest pain or funny heartbeats?
• Was your child on any medications?
• How long did the event last?
• How quickly did your child recover?
• Does your child have known medical problems?
• Is there any family history of fainting, seizures, heart attacks, or sudden death?
• What were the environmental conditions prior to the event?

Physical

Your physician will perform a routine physical examination.  She will likely check closely the following:

• mental status
• blood pressure
• heart rate
• cardiac exam
• pulses
• neurologic exam

Lab testing may include:

• blood tests
• urine tests
• blood sugar
• pregnancy test
• hemoglobin level
• illegal drug testing

Imaging and other studies may include:

• EKG (if there is concern about a heart rhythm disturbance)
• Holter monitor (basically a longer-term EKG)
• Echocardiogram (if there is concern about a heart function or anatomy problem)
• EEG (if there is concern about possible seizures)
• Tilt table testing (a test designed to help diagnose vasovagal syncope, not often used in kids)

What is the treatment for fainting or syncope?

The treatment depends on the specific cause.  The most common, and benign causes of fainting often required no treatment.

What is the prognosis after a fainting episode?

This depends on the specific cause.  This should be discussed with your doctor.

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