Fainting Attacks Amongst Children and Young Adults

A passed out child. (Top Photo Group/Thinkstock)
A passed out child. (Top Photo Group/Thinkstock)

A young man visits his doctor with a history of recurrent fainting attacks. Parents are worried. They want to know what could be the cause.

A transient, self-limited loss of consciousness, usually leading to falling is termed as syncope. Syncope is a common clinical problem accounting for five per cent of hospital admissions and up to three to five per cent of emergency department visits.

Syncope is a major challenge for the practicing physicians. It is very important to know the cause and clinical characteristics of syncope in children. Although most often benign, it can be a symptom of serious underlying conditions. It is estimated that 15-40 per cent of children and young adults have had at least one episode of syncope. Approximately one to two per cent of children presenting with syncope have a serious underlying disorder.

A paper published by the Department of Pediatrics, Peking University, retrospectively analyzed the causes of syncope and diagnostic workup of 154 consecutive children.

They found autonomic-mediated reflex syncope (also known as vaso-vagal or neuro-cardiogenic syncope) was the most common cause in 65.6 per cent of children, whereas cardiac disorders were found in 10 cases (6.5 per cent) comprising the second cause of syncope in children.

Other causes included psychological, neurological and metabolic disorders. Although many causes were studied, 25 cases (16.2 per cent) were found to have no definite cause for their syncope.

Vaso-vagal syncope is a temporary loss of consciousness associated with a drop in arterial blood pressure, quickly followed by a slowed heart rate. It usually occurs while standing. It may happen while a person is lying down. Emotional stress, stressful condition and pain may trigger an episode.

The fainting may occur suddenly or is associated with warning symptoms such as fatigue, weakness, nausea, sweating, pallor, visual disturbances, abdominal discomfort, headache, pins-and-needles, lightheadedness or vertigo. A person may feel hot or cold. He or she may have slurred speech and keeps yawning. During the faint “seizure-like” activity may occur.

Diagnosing vaso-vagal syncope is usually not difficult. It has a typical history and always completely normal physical examinations and ECGs. It is commonly seen in pubertal girls, but can happen in males. Usually, there is a clear precipitating cause of syncope.

Cardiac syncope can have be associated with life-threatening diseases. Therefore finding a cause for cardiac syncope is very essential.

A thorough medical history, ECG and echocardiography (ultrasound of the heart) can reveal life-threatening cardiac causes of syncope. Twenty-four-hour monitoring of the heart rhythm (Holter monitor) also helps in the diagnosis. Cardiac syncope often occurs suddenly or during exercise. Children with cardiac syncope often have history of cardiac diseases and they were often younger.

The authors of the Peking paper say that neurological causes of syncope should be considered if syncope is associated with seizure activity, syncope spells seen in any position, there is disorientation or neurologic abnormal signs. Diagnostic tests like EEG, CAT scan and MRI should be able to give us an answer.

A metabolic cause was entertained when the child had a history of metabolic diseases, prolonged anger or violent vomiting and diarrhea. Children with psychiatric disorders were adolescent girls with prolonged syncope spells and had more frequent syncopal episodes.

In summary, syncope in children may result from a wide variety of causes. In most cases, appropriate investigations will give us the diagnosis. History taking, physical examination and electrocardiography are the core of the syncope workup. Most causes of syncope are benign.

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Comments

  1. My daughter is 7 and every time she vomits she faints eyes rolls back and she is very pale and weak for the night she can’t walk..i have asked for a referral and doctor ran tests and said she was fine which she is not this has been happening for over 8months and everytime she vomits…can some one plz help I am lost and am very concerned as we are going through it right now as we speak.

  2. My 2.5 year old daughter fainted today while playing with her older brother. First time this has ever happened. She came to and seemed really tired and slightly disoriented, this lasted roughly an hour. Not too sure what to make of it. Hoping to get the ball rolling tomorrow with our pediatrician?

  3. hi
    i am a 29yr male with faint attackes.
    i have blood tests,ECG,C.T scan,ECO.nothing was found.

  4. Hi My 16 year old daughter fainted in our kitchen on sunday and it was a sight that terrofied me to see we was eating dinner she was comin in for more n she said i need to lay down and within seconds she fell into me i caught her n then she was or seemed lifeless? unconcious we packed her out of the kitchen into living room her eyes were closed but i kept talkin to her to open her eyes n holding her, she opened her eyes but seemed like she was disoriented like drunk but not? and we gave her some vitamin water to drink took her to childrens hospital and they let us wait for 5 hrs before looking at her? gave her some juice n cookies n food asked her some Qs no doctor came in for 5 hrs? she did a ekg or something but it wasnt no 24 hrs more like a minute or 2? blood tests urine test few hrs later they said ok tests were good n she can go home with no answer? this happened to her 7 years ago when she was at my gramparents place n they didnt take her to the hospital they jus thought she mighta been hungry n fed her n put her to bed? well now this 2nd time i was there n seen it happen n i dont want to see it happen again? i am lookin for a new doctor as we now live in a new city? dont have a family doctor what can I do? or ask for to help us find out what can be wrong? maybe im over paranoid i just doesnt seem normal to me?

    • No you are not over paranoid at all, you need to get to the bottom of this. Also, make sure you do your research at home before going to doctor. You need to ask the right questions and coming from a medical family. It is amazing to see how doctors in this current age easily ignore things till it becomes a bigger issue. My son who is turning 3 this October, seems to have fainting spells where he just sits down and has no energy and turns pale white as ghost. First time it happens they ran all the test and told us everything looks normal after 5 months it happened again. so i am going to get to the bottom of this till i get my answers and i would urge you to do the same. Ignoring is becoming a norm in the health care and very few doctors would take time to investigate unless parents really stay on the top of things.

  5. Annabelle Lee says:

    I am 14 years old and have a serious fainting problem. I’ve fainted almost 10 times since September. I’ve been to the cardiologist and they gave me a heart monitor, my heart’s fine. It only happens in school and is usually in the morning. I’m going to the neurologist next week because the pediatrition thinks it may be a very low case of epilepsy. (In this case, petite mal). I would like to know if anyone has an answer. It’s getting really annoying. Thank you.

  6. my husband's 8 yr old daughter has frequent fainting spells after which she sleeps for a few hours and is perfectly fine but with no memory of it. it has happened in school and whilst outside. she has had 24 hr heart monitor and brain scan all of which showed nothing. she has since had a test on her kidneys and the results show white cells and test needs repeating. is this common, could it be serious or is it at all common in girls of her age. would it matter that she has a tiny appetite and frame. thank you

  7. I am researching causes of fainting in Toddlers. My 3 year old grand daughter has had atleast 3 episodes that she losses conciousness. I was not present with the first incident. The second time she got as stiff as a board, her eyes rolled up in her head and than she fainted. She came out of it with in a few seconds and then was very pale and weak for a half hour or so. The third time was within four months of the first incident. It was early in the morning and she walked up to me as she became very limp and said Grandma I feel very tired and then lost conciosness. She regained herself within seconds but stated vomiting and was pale. After the second incident she was tested by a cardiologist who found a slight arythmia. What should we do next! Thanks for any insight.

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