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Quick Take: Why do kids faint?

Syncope is common and can be a warning sign of a structural or electrical abnormality in the heart that may cause sudden death


Image Greg Friese

A child fainting, which is a syncopal episode, may be a significant medical event that requires a careful EMS assessment. Dr. Rhiana Ireland, an attending physician and EMS director, discussed causes, assessments, and treatments for children and adolescents that faint in a session at EMS Today in Baltimore, Md.

Overview of pediatric syncope

Syncope is a sudden brief loss of consciousness associated with loss of postural tone from which recovery is spontaneous. Syncope in children and adolescents is common and costly for EMS response and health care assessment of the cause. Fainting can be disabling for some children and most importantly syncope is a potential warning sign of sudden death.

Memorable quotes about pediatric syncope

“Twenty five percent of kids that DIE suddenly had a history of syncope. The previous episode may have been only chance to identify malignant syncope and save a child’s life.”

Key Takeaways

  • Syncope is common. Twenty to 50 percent of adolescents experience a syncopal episode
  • Exercise, emotion or stress, and loud noise may trigger a syncopal episode.
  • Benign syncope, which is also known as vasovagal syncope is the most common type. This type has an identifiable cause that can be modified. Patient’s sense it coming and recovery quickly with no post-ictal period.
  • Malignant syncope is due to an underlying dysrhythmia, like prolonged QT-syndrome, or a structural abnormality, like cardiomyopathy, to the heart. Malignant syncope reveals itself intermittently because of an interruption of cardiac output. This type begins and ends abruptly.
  • Assessment for any syncopal episode should include vital sign monitoring, 12-lead ECG, and continuous EKG monitoring.
  • Seizures are not a syncopal episode. The post-ictal period is the distinguishing feature.

Learn more about pediatric syncope

Ireland showed several videos during the presentation of pediatric syncopal episodes. She used these to discuss benign versus malignant syncope, as well as syncope mimics. EMS educators could utilize these videos to discuss assessment and treatment of syncope.

Benign syncope: child faints during spelling bee

Malignant syncope: soccer player collapses during game

According to Ireland the cause of this fatal incident was a structural abnormality, cardiac myopathy.

Syncope mimic: breath holding spell

Pediatric syncope assessment and treatment

EMS providers may not appreciate the severity of a syncopal episode or a syncopal mimic, like intentional choking or fainting games. A thorough assessment, including a history, physical exam, blood sugar, and 12-lead ECG, is necessary to diagnose the cause of the syncopal episode.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.