Fainting (syncope) is characterized by short-term loss of consciousness and falling in children. It usually develops due to a sudden drop in blood pressure or cardiac causes. Although it is benign in most cases, detailed neurological and cardiac evaluation is required.

Reflex syncope is the most common type of fainting seen in children. It may occur with triggers such as standing for a long time, stress, or sudden pain. This condition usually does not indicate a serious disease, but advanced evaluation is required in frequently recurrent cases.

Syncope developing due to neurological causes may be confused with epileptic seizures. Detailed observation of the child’s attacks, EEG examination, and imaging methods if necessary are important for correct diagnosis. In this way, a distinction can be made between epilepsy and syncope.

The primary aim in treatment is to determine the underlying cause. There may be fainting episodes that can be controlled with simple measures, while in some cases drug treatment or advanced cardiological interventions may be required. Regular follow-up is important in preventing recurrent attacks.

What Is Fainting (Syncope) in Children?

Fainting is actually a very clever defense mechanism of our body, we can say. Our brain, just like the engine of a car, constantly needs oxygen and nutrients. These oxygen and nutrients are carried through the blood. If an adequate amount of blood does not reach our brain, its “energy is cut off” for a moment, and this leads to loss of consciousness. This condition usually lasts very briefly, from a few seconds to a few minutes. Afterward, blood flow returns to normal and our child recovers quickly.

We can sometimes compare fainting to a computer freezing momentarily. When it is doing too much processing or encounters an unexpected situation, the computer does not respond for a moment, but then everything returns to normal. Similarly, the human body may experience sudden changes in blood pressure or heart rate in some situations, and this may cause the brain to “freeze” briefly, that is, to faint.

What Are the Causes of Fainting (Syncope) in Children?

There may be many different causes of fainting in children. A large portion of these are harmless and temporary. One of the most common causes is neurocardiogenic syncope. We can think of this as a condition that occurs as a result of the nervous system, which controls our body’s blood pressure and heart rate, overreacting. This type of fainting may occur especially in situations such as standing for a long time, being in a hot environment, becoming overly excited, or being frightened. It is as if our body suddenly “panics” and reduces blood flow to the brain by lowering blood pressure.

Another common cause is orthostatic hypotension. This is the condition in which our blood pressure drops suddenly when we stand up. Normally, when we stand up, our body activates certain mechanisms to balance blood pressure. However, sometimes these mechanisms are not sufficient, and especially due to rapid growth during adolescence, dehydration, or the effects of some medications, blood pressure may drop, which may lead to dizziness and even fainting. You can think of it like the pressure of water dropping for a moment when we suddenly turn on a tap.

A rarer but important cause is cardiac syncope, that is, fainting caused by the heart. A structural problem in the heart or an arrhythmia may prevent the heart from pumping enough blood, and this may cause fainting. This type of fainting usually occurs during or after exercise and needs to be examined more carefully. If we think of the heart as a fuel pump, if the pump does not work properly, enough fuel (blood) does not go to the engine (brain), and the vehicle (body) stops.

Apart from these, some metabolic problems (such as low blood sugar), neurological conditions (such as migraine), or some reflexes (such as coughing, urination) may also cause fainting. In addition, breath-holding spells seen in small children may also lead to short-term loss of consciousness. Sometimes fainting called psychogenic syncope may also be seen due to psychological factors.

What Are the Types of Fainting (Syncope) Seen in Children? Is Every Fainting Episode the Same?

No, not every fainting episode is the same. The most common type of fainting encountered in children, as we mentioned before, is neurocardiogenic syncope. This type of fainting usually occurs with a triggering factor, and before it there may be symptoms such as dizziness, lightheadedness, nausea, paleness, sweating, and visual changes. These symptoms may give the child time to sit or lie down, and thus injuries due to falling can be prevented.

Another type is orthostatic syncope. This especially occurs as a result of excessive drop in blood pressure when standing up from a lying or sitting position. Dizziness and lightheadedness are its most prominent symptoms. Sometimes a condition called Postural Orthostatic Tachycardia Syndrome (POTS) may also cause orthostatic intolerance and fainting. In POTS, there is an excessive increase in heart rate (usually more than 30-40 beats per minute or above 120) within 5-10 minutes after standing up, but there is no significant drop in blood pressure.

Cardiac syncope, on the other hand, is fainting caused by heart diseases. This type of fainting may occur because the heart cannot pump blood sufficiently or because of sudden changes in heart rhythm. Fainting during exercise, especially fainting without being able to stop the exercise, may suggest a cardiac cause and requires a more detailed evaluation.

Apart from these, syncope due to other causes may also be seen. For example, conditions such as seizures, migraine, and low blood sugar may lead to symptoms similar to fainting. Therefore, careful evaluation is important for the correct diagnosis.

What Should I Do When My Child Faints (Has Syncope)?

When your child faints, first of all it is very important to remain calm. Instead of panicking, you should act quickly and correctly:

• Lay your child down gently on the floor. If possible, make sure they are in a supine position and on a flat surface. You may prevent blockage of the airway in case of vomiting by turning the head slightly to the side.
• Check whether your child is breathing. Watch chest movements and if necessary bring your cheek closer to feel their breath.
• If possible, raise your child’s legs about 20-30 cm. This may help the blood go toward the brain. Just as when there is a blockage in a water pipe, lifting the pipe upward may facilitate the flow of water.
• If your child is wearing tight clothes (for example a tie, belt), loosen them. This will ease blood circulation.
• Do not try to wake your child by shaking them or sprinkling water on their face. They will usually wake up on their own within a few seconds or minutes.
• Track how long the fainting lasts. This information may be important for your doctor.
• After your child wakes up, calm them down and allow them to rest. Tell them to avoid sudden movements.

If your child is fainting for the first time, if the fainting lasted long, if they have difficulty breathing, if they have complaints of chest pain or palpitations, if they had seizure-like convulsions, or if you have concerns about the cause of the fainting, definitely consult a doctor. Especially fainting during exercise is a condition for which a specialist should be consulted without losing any time.

Remember, most fainting episodes are harmless and pass on their own. However, consulting a doctor is always the best course of action in order to understand whether there is a serious underlying condition.

How Is Fainting (Syncope) Diagnosed in Children?

Finding the cause of fainting in children is just like a detective following clues. Your doctor will first conduct a detailed medical history interview with you and your child. In this interview, many questions will be asked, such as when, where, and under what circumstances the fainting occurred, and what happened before and after it. Your child’s general health condition, the medications they use, and whether there is a history of fainting in the family are also important pieces of information.

Then, your doctor will perform a physical examination. In this examination, they will evaluate your child’s heart rate, blood pressure (both while lying down and after standing up), general appearance, and neurological condition. Listening to heart sounds may indicate a possible heart problem.

An important part of the diagnostic process is also the electrocardiogram (ECG). ECG is a simple and painless test that records the electrical activity of the heart. It can be very helpful in detecting rhythm disorders or structural problems in the heart. ECG is a test that is recommended to be performed in all children who experience fainting, especially at the first fainting episode.

In some cases, your doctor may request advanced tests to understand the underlying cause more clearly. These tests may include:

Tilt Table Test: This test is performed especially when neurocardiogenic or orthostatic syncope is suspected. The child is laid on a table and while the table is tilted upward at certain angles, heart rate and blood pressure are continuously monitored. This allows fainting to be triggered in a controlled environment and the body’s response to be evaluated.

Holter Monitor: This is a portable device that continuously records the electrical activity of the heart for 24 to 48 hours. It is especially useful in detecting intermittent rhythm disorders.

Exercise Stress Test: This test is performed in children who faint during or immediately after exercise. While the child exercises on a treadmill or bicycle, heart rate, blood pressure, and ECG values are monitored.

Echocardiogram: This is the ultrasonographic examination of the heart. It shows the structure and function of the heart in detail. It is generally requested when heart-related fainting is suspected.

Your doctor will decide which tests to perform according to your child’s history, physical examination findings, and ECG results. The aim is to determine the cause of the fainting accurately and plan the appropriate treatment.

How Is Fainting (Syncope) Treated in Children?

The treatment of fainting in children is primarily directed toward the underlying cause of the fainting. In most cases, especially in neurocardiogenic syncope, non-drug treatment methods are quite effective.

• Lifestyle Changes: Avoiding triggering factors is the most important step. It is important to avoid standing for a long time, hot and crowded environments, and to learn to cope with emotional stress.
• Plenty of Fluid and Salt Intake: Increasing daily fluid intake and consuming an adequate amount of salt may help maintain blood volume and prevent blood pressure from dropping. You can think of it like pumping more air into a balloon to prevent it from deflating.
• Recognizing Prodromal Symptoms and Taking Precautions: It is important for children to recognize symptoms they feel before fainting, such as dizziness and lightheadedness, and in that situation to immediately sit or lie down and raise their legs. This may prevent fainting or at least reduce the risk of falling.
• Contraction Maneuvers: In some cases, maneuvers such as crossing the legs or tightening the leg muscles may help raise blood pressure before fainting.

If lifestyle changes are not sufficient, drug treatment may be considered in some cases. In orthostatic hypotension or vasovagal syncope, medications that help raise blood pressure may be used. However, the use of these medications should be under a doctor’s supervision.

In heart-related fainting, treatment is directed toward the underlying heart problem. This may include drug treatment, surgical intervention, or the placement of devices such as a pacemaker.

It should be remembered that in most children fainting is benign and may improve spontaneously over time. The important thing is to make the correct diagnosis and take appropriate precautions.

In Which Situations Should a Specialist Be Consulted for Fainting (Syncope) in Children?

Although fainting in children is generally harmless, some situations require greater attention and consultation with a specialist. Here are those “red flags”:

• Fainting During Exercise: This may indicate an underlying heart problem and should definitely be evaluated by a pediatric cardiology specialist. Just like a car suddenly stalling while going uphill, fainting during exercise may show that there is a problem at a moment when the heart is under strain.
• Fainting Without Warning Signs: The absence of symptoms such as dizziness and lightheadedness before fainting, especially fainting suddenly and unexpectedly, may suggest a cardiac cause.
• Fainting While Lying on the Back: This condition is also generally not associated with neurocardiogenic syncope and may require investigation of a more serious cause.
• More Than One Fainting Episode in a Short Time: Frequently recurring fainting indicates that there may be an underlying problem.
• Family History of Sudden Cardiac Death or Hereditary Rhythm Disorder: If there are unexplained deaths at a young age or known heart rhythm disorders in the family, your child’s fainting should be taken more seriously.
• Chest Pain or Palpitations Before Fainting: These symptoms may be signs of a heart-related problem.
• Abnormal Findings on Physical Examination: Hearing abnormal sounds such as a murmur in the heart or abnormal vital findings such as a marked decrease or increase in heart rate requires consultation with a specialist.
• Abnormal Findings on ECG: If findings such as a long or short QT interval, Brugada pattern, pre-excitation (WPW syndrome), significant rhythm disorders, or thickening of the heart muscle are detected on ECG, a cardiology specialist should also be consulted.
• Seizure-Like Movements: If there are seizure-like situations such as prolonged loss of consciousness, convulsions, or confusion during or after fainting, it may also be necessary to consult a pediatric neurology specialist.

In such situations, consulting a specialist without losing time is of vital importance in terms of making the correct diagnosis and starting the necessary treatment. Remember, early diagnosis can prevent serious problems in many cases.

Frequently Asked Questions

What are the most common causes of fainting in children?

Fainting in children generally occurs due to harmless causes such as vasovagal reflex, sudden fear, pain, standing for a long time, or fluid loss, but underlying heart or neurological diseases should also be investigated.

How can heart diseases present during fainting in children?

Heart rhythm disorders, structural heart diseases, or conditions that obstruct blood flow in the heart may lead to a fainting episode; if fainting occurs during exercise, cardiac evaluation is essential.

What lifestyle changes are recommended to prevent recurrent fainting in children?

Regular water consumption, avoiding standing for a long time, avoiding sudden movements, and balanced nutrition may be beneficial in reducing the risk of fainting episodes.

What should be done if dizziness and palpitations are seen together with fainting in children?

If there are complaints such as dizziness, palpitations, or chest pain before the fainting episode, urgent medical evaluation is required against the possibility of a serious underlying heart or neurological disease.

What are the neurological diseases underlying fainting in children?

Neurological conditions such as epilepsy, migraine, brain tumor, or neurometabolic diseases may lead to fainting; neurological examination is performed if suspected.

What are the first aid steps that should be taken after fainting in children?

If the child has fainted, the head should be turned to the side and the feet should be elevated, tight clothes should be loosened, and the environment should be ventilated; if consciousness does not return quickly, medical help should be called.

What complications are seen after fainting in children?

Injuries such as head trauma, tooth fracture, or tongue biting may develop as a result of falling during fainting; examination is essential for complications.

In which situations are fainting episodes in children considered serious?

If it occurs during exercise, upon waking from sleep, if there is a family history of sudden death, or if a seizure accompanies the fainting, urgent specialist evaluation is required.

Which medications or toxic substances can cause fainting in children?

Some antihistamines, antidepressants, blood pressure medications, or toxic substances may increase the risk of fainting in children; medication use should be questioned.

When is detailed cardiological evaluation required after a fainting episode in children?

If fainting is accompanied by palpitations, chest pain, a family history of heart disease, or fainting during exercise, cardiological evaluation should be performed.

Which Department or Doctor Should Be Consulted for Fainting (Syncope) in Children?

Although fainting in children is mostly due to temporary and benign causes, there may be an underlying neurological or cardiac problem. For this reason, it is appropriate to first apply to the Pediatric Neurology department for detailed evaluation.