Overview of syncope in children
Syncope in children is a brief loss of consciousness and muscle tone (or posture) that occurs when there is not enough blood in the brain. Syncope is commonly known as epilepsy. In most children, it is usually harmless. But in some children, the syncope is severe. Epilepsy can be caused by a heart problem or sometimes by a neurological problem.
What causes syncope in children?
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 in 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
- Inner ear problems
- Low blood sugar
- Breath-holding episodes (Typically in children 6 months to 2 years of age)
- Brain mass
- Aneurysm or abnormality of the blood vessels of the brain
- Having a bowel movement
What are the symptoms of syncope in children?
Some children show symptoms before they faint. Children can have:
- Mild headache
- Changes in your vision
- Clammy 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.
Diagnosis of syncope in children
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?
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 children?
After an episode of syncope in children, 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.
Complications of syncope in children
Most syncope in children is not dangerous. In a small number of children, severe heart problems can cause 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 a healthcare provider?
Call your child’s provider if he or she has syncope, especially:
- It occurs with irregular heartbeats.
- Occurs with exercise
- You have a family history of syncope.
- It occurs in exceptional and dangerous situations.
- Subsequent injuries occur
Important points about syncope in children
- Syncope in children 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 in children 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.