What should you know about pediatric syncope?

A child may feel warm, dizzy, nauseated, weak, or see spots before fainting. The episode is usually brief, followed by gradual recovery. Triggers can include prolonged standing, pain, fear, heat, missed meals, or not drinking enough. Some children faint after standing up quickly.

Fainting can also occur with dehydration, low blood sugar, anaemia, or a heart rhythm problem. A clinician may ask what happened before and after the event, review medicines and family history, check vital signs, and perform an examination. An electrocardiogram may be considered to assess the heart’s rhythm.

If a child feels faint, have them lie flat with their legs raised, loosen tight clothing, and move them away from heat or danger. If they lose consciousness, place them on their side if they are breathing and check that they respond. Do not give food or drink until they are fully awake.

Note the child’s position, activity, symptoms, colour, breathing, duration of unconsciousness, movements, and recovery. Arrange medical review after a first faint, after repeated episodes, or when the cause is unclear. Encourage regular fluids and meals when appropriate, and ask the clinician about safe activity until the assessment is complete.

Call emergency services if the child is not breathing normally, does not wake promptly, has a seizure, remains confused, is seriously injured, or has chest pain or severe breathing difficulty. Urgent assessment is also needed when fainting happens during exercise, while lying down, or with a sudden racing or irregular heartbeat.

Seek prompt medical advice when episodes repeat, occur without warning, or are accompanied by severe headache, weakness, persistent vomiting, or a family history of sudden unexplained death or significant heart disease. Do not let the child drive, swim alone, climb, or return to strenuous sport until a clinician gives clear advice.

Ask whether the episode sounds like reflex fainting or needs heart testing, whether blood tests are appropriate, and when the child may return to sports. Discuss hydration and meal routines, warning symptoms to record, medication effects, and whether relatives’ heart histories change the assessment.