Fainting (Syncope) In Children: Causes, Symptoms And When To Worry

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Fainting or syncope is a condition wherein a person loses consciousness due to insufficient blood pressure in the brain. When there is low blood pressure in the brain, the body immediately takes blood from other parts and supplies it to the brain. Thus, when a person faints, they usually fall over or lie flat on the ground, making it easier for the blood to reach the brain.

In most cases, fainting in children may not be severe and may resolve or improve on its own. You may often find children fainting during adolescence. However, if the fainting episodes are recurrent and you notice other abnormal signs, it could indicate an underlying medical condition.

Read this post to learn about the causes, signs, and various treatment options for fainting in children.

Causes Of Fainting In Children

The causes of syncope can be divided into three categories.

  1. Neurally mediated syncope (NMS) or vasovagal syncope: This is the most common cause of syncope in children. It is associated with hypersensitivity of the baroreceptors in the blood vessels after a sudden change in posture. An episode of syncope is generally initiated by emotional stress, fear, anxiety, anemia, dehydration, hunger, physical exhaustion, or a crowded or poorly ventilated space.

The following symptoms can help identify it:

  • Prodrome (early signs of the onset of a disease) that lasts for several seconds to minutes
  • A brief period of unconsciousness
  • Lightheadedness
  • Dizziness
  • Nausea
  • Shortness of breath
  • Paleness
  • Sweating
  • Visual changes

This type of fainting is common in children and generally resolves on its own or when the underlying temporary cause is cured (1).

  1. Cardiac syncope: This type is less common than NMS but might be due to an underlying medical condition. Cardiac syncope can further be divided into two subcategories:
  • Primary anomalies: These include right or left heart obstruction, pulmonary hypertension, cyanotic heart defects, congestive cardiomyopathies.
  • Arrhythmias: These include ventricular tachycardia, long QT syndrome, and postoperative martial flutter.

Cardiac syncope is characterized by:

  • Little or no prodrome
  • Loss of consciousness for longer than five minutes
  • Chest pain or palpitations
  • Shortness of breath

This type of fainting is mostly found in children with a family history of cardiac diseases, cardiomyopathy, or sudden death (1).

  1. Non-cardiovascular: This type of fainting can be due to a head injury, seizures, basilar migraine, inner ear problems, low blood sugar, anemia, coughing, and orthostatic hypertension (drop in blood pressure when the child has been standing for a while) (2).

Next, let us look at the signs of syncope in children.

Signs Of Fainting In children

Although some signs of fainting may be specific to the type of syncope, here are a few common symptoms of fainting in children.

  • Dizziness
  • Seeing spots or dark vision
  • Perception of ringing in the ear or muffled sounds
  • Nausea
  • Feeling hot or cold
  • Increased or decreased heartbeat
  • Paleness

These could be the early warning signs before the child finally faints and falls over (3).

Risk Factors Of Fainting In Children

Irrespective of the cause, fainting in children can carry certain risk factors. Children who faint and suddenly fall may hit hard surfaces, causing head or other injuries. Fainting can also indicate temporary problems such as anemia and low blood sugar, which may need interventions.

Cardiovascular syncope has an additional risk of causing heart diseases and could lead to serious health complications if not treated early on.

So, if your child experiences syncopal episodes, it is best to get them diagnosed to find out the underlying cause. Read the next section to understand the diagnostic procedure for fainting in children.

Diagnosis Of Fainting In Children

Your child’s doctor would recommend a thorough clinical evaluation, including taking a physical examination and learning the child’s clinical history.

The physical examination includes a complete cardiac examination with stress on pulse rate, clicks, gallops, and murmurs, to determine if it the fainting is caused by a cardiac problem. An electrocardiogram (ECG) should also be included in the evaluation.

The doctor would also ask you questions about the child’s medical history, such as a family history of syncope, cardiomyopathy, or sudden death. Blood tests to determine the iron content and the presence of low blood sugar may also be recommended (1).

When To See A Doctor?

Take your child to the doctor if you notice the following symptoms.

  • Recurrent episodes of fainting
  • Fainting following a head injury
  • Passing out for more than one minute
  • No urine for more than eight hours
  • Unknown cause of fainting
  • Tightness in the chest.
  • Exercise-induced fainting

Whether it is a benign condition or an underlying condition, fainting in children needs to be treated early on. The next section covers the treatment options.

Treatment For Fainting In Children

The treatment for syncope depends on the underlying cause.

For NMS and noncardiovascular syncope

  • The first line of treatment includes behavior modifications, such as avoiding dehydration and prolonged periods of standing and having meals at regular intervals.
  • Other simple tips include drinking a mixture of water and table salt to increase the plasma volume.
  • You can also try giving them iron-rich foods if the syncope is due to anemia.

If the fainting persists, your child’s doctor might prescribe medications, such as a beta-blocker or fludrocortisone. If the syncope has occurred following brain injury or if the child is diagnosed with low blood sugar, talk to your doctor for an appropriate course of action.

For cardiac-related syncope, the child’s doctor might recommend medications, such as beta-blockers, or surgical interventions (1).

Prevention Of Fainting In Children

Take the following precautions to prevent fainting in children.

  1. Make sure your child stays hydrated throughout the day, especially when they are playing or doing exercises.
  1. If your child is diagnosed with low blood pressure, monitor their blood pressure, and follow your doctor’s dietary advice.
  1. If your child has to stand for a long time, ask them to shift positions and bend at the waist occasionally; these will ensure proper blood circulation to the brain.
  1. Avoid crowded and suffocating places.
  1. Avoid standing for prolonged hours during the day, especially when it is hot.
  1. Teach your child to identify the early warning signs of fainting and ask them to lie down and put their legs up.
  1. If your child tends to pass out upon standing, ask them to stand or sit slowly. While getting out of the bed, instruct them to put their legs out of bed, move the toes, and take a few deep breaths before standing.

Most fainting cases in children may not be due to an underlying medical condition, but an episode of fainting can cause worry and concern to the parents. Sometimes, children can also get into danger if they faint and fall on hard surfaces. So, it is important to understand the underlying cause for fainting and take steps to resolve it early on.

References:

1. Jean-Marc Côté; Syncope in children and adolescents: Evaluation and treatment; Pediatrics Child Health (2001).
2. Syncope in Children; University of Rochester Medical Center
3. Fainting (Syncope); Children’s Hospital of Philadelphia

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