“Syncope” or transient loss of consciousness is very common in children (15% of children between 8-18yrs). It can happen due to a variety of reasons and therefore a thorough evaluation is very important so that the management is effective.

Cardiac (Heart-related) causes of syncope is unusual but can be life-threatening. It is also important to rule out syncope mimics like epilepsy (seizures), cataplexy, pseudo syncope, drop attacks &TIAs (transient ischaemic attacks)

Syncope in Children

Here are some of the ways syncope is caused in children. The usual investigations are ECG, echocardiogram, Ambulatory ECG, Tilt tests & Exercise stress testing. These might not be done in all patients but depends on the history and examination findings.

Neurally mediated (through vagal nerve stimulation)

Types could be vasovagal (simple faint), micturition syncope (during passage of urine) or reflex asystolic.

Orthostatic syncope

Here the types could be vaso-depressor (fall in blood pressure), cardioinhibitory (fall in heart rate) & POTS (Postural orthostatic tachycardia syndrome).

Cardiac syncope

Arrythmias (abnormal rhythm), Aortic stenosis (tight main artery valve), HOCM (Hypertrophic cardiomyopathy), CPVT (Catecholaminergic polymorphic ventricular tachycardia) etc.

Red Flags

Prolonged loss of consciousness (>5min), Need for CPR , Family history of sudden unexplained deaths, Exercise-induced syncope, Palpitations or chest pain.

Treatment depends on the cause & could be only general advice to use of medications, defibrillators or referral to other specialists like geneticists, cardiologists or psychologist.

It is vital that the child is seen by a paediatrician with expertise in the management of syncope so that he or she is diagnosed appropriately and safely managed.