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Man fainting. Fainting in Children and Adolescents: Causes, Symptoms, and Treatment Options

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What are the common causes of fainting in young people. How can you recognize the symptoms of syncope. What should you do if your child faints. When is fainting a sign of a more serious condition. How is syncope diagnosed and treated in children and teenagers.

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Understanding Syncope: The Medical Term for Fainting

Fainting, medically known as syncope, is a common occurrence in children and young adults. Approximately 20% of young adults report having fainted at least once in their lives. Despite its prevalence, fainting episodes can cause significant concern for both patients and their caregivers, often due to fears of underlying serious conditions or sudden death risks.

Syncope is characterized by a sudden, temporary loss of consciousness caused by a decrease in blood flow to the brain. While usually benign in nature, it’s essential to understand the various causes, symptoms, and potential red flags that may indicate a need for further medical evaluation.

Recognizing the Warning Signs: Symptoms Preceding a Fainting Episode

Before a fainting episode occurs, individuals often experience a range of warning signs. These pre-syncope symptoms can include:

  • Dizziness
  • Muffled hearing
  • Visual changes (such as “blacking out” or tunnel vision)
  • Lightheadedness
  • Nausea
  • Sweating
  • Paleness

These symptoms are more likely to occur in hot environments or when changing positions from sitting or lying down to standing. It’s important to note that many people may experience these symptoms without actually fainting.

How can you prevent fainting if you notice these warning signs?

If you or your child experiences these pre-syncope symptoms, take immediate action to prevent a full fainting episode:

  1. Sit or lie down immediately
  2. Place your head between your knees if sitting
  3. Stay in this position until the symptoms subside
  4. Slowly return to an upright position
  5. Seek medical attention if symptoms persist or recur frequently

The Primary Culprit: Vasovagal Syncope in Children and Adolescents

Vasovagal syncope, also known as neurocardiogenic syncope, is the most common cause of fainting in children and adolescents, accounting for over 90% of cases. This condition is caused by changes in the autonomic nervous system, which controls involuntary bodily functions.

In vasovagal syncope, there’s an inappropriate relaxation of blood vessels (vasodilation) when they should be constricting. In some cases, the heart rate may also slow down (bradycardia) instead of increasing. These changes result in a sudden drop in blood pressure, leading to dizziness and fainting.

What triggers vasovagal syncope?

Common triggers for vasovagal syncope include:

  • Standing for long periods
  • Dehydration
  • Emotional stress
  • Pain
  • The sight of blood
  • Sudden changes in posture
  • Hot environments

When Fainting Becomes a Concern: Red Flags for Cardiac Issues

While most cases of fainting in children and adolescents are benign, there are certain situations where it may indicate a more serious underlying cardiac condition. These cases, although rare, require prompt medical attention and evaluation by a cardiologist.

Red flags that warrant further cardiac investigation include:

  • Fainting that occurs during physical exertion
  • Syncope without warning signs (no dizziness, muffled hearing, or visual changes)
  • Fainting episodes resulting in severe injury
  • Family history of sudden unexplained death, cardiomyopathy, or congenital heart disease
  • Abnormal cardiac exam or ECG findings

What cardiac conditions can cause syncope in young people?

Although rare, cardiac-related causes of syncope in children and adolescents can include:

  1. Structural heart defects (e.g., aortic valve stenosis, hypertrophic cardiomyopathy)
  2. Abnormal heart rhythms (e.g., long QT syndrome, Wolff-Parkinson-White syndrome)
  3. Reduced heart function (e.g., dilated cardiomyopathy, myocarditis)
  4. Pulmonary hypertension
  5. Coronary artery anomalies

Diagnosing the Cause: Medical Evaluation and Testing for Syncope

When a child or adolescent experiences fainting episodes, a thorough medical evaluation is crucial to determine the underlying cause and rule out potentially serious conditions. The diagnostic process typically involves several steps:

What does a typical syncope evaluation include?

  1. Detailed medical history: The healthcare provider will ask about the circumstances surrounding the fainting episodes, any warning signs, and family medical history.
  2. Physical examination: This includes a thorough cardiac and neurological exam.
  3. Electrocardiogram (ECG): A standard test to screen for abnormal heart rhythms and other cardiac issues.
  4. Additional tests (if needed):
    • Echocardiogram: An ultrasound of the heart to assess its structure and function
    • Graded exercise test (GXT): To evaluate the heart’s response to physical exertion
    • Electroencephalogram (EEG): To rule out seizures as a cause of loss of consciousness
    • Tilt table test: To provoke vasovagal syncope in a controlled setting

Managing Vasovagal Syncope: Lifestyle Changes and Prevention Strategies

For most children and adolescents diagnosed with vasovagal syncope, treatment focuses on lifestyle modifications and preventive measures rather than medication. These strategies aim to reduce the frequency and severity of fainting episodes.

How can you prevent vasovagal syncope through lifestyle changes?

Effective management strategies for vasovagal syncope include:

  • Increasing fluid intake: Aim for 70-80 ounces of fluid per day to maintain proper hydration
  • Increasing salt intake: This helps maintain blood volume and pressure (consult with a healthcare provider first)
  • Avoiding triggers: Identify and avoid situations that may provoke fainting
  • Eliminating caffeine: Reduce or eliminate caffeine consumption
  • Recognizing warning signs: Learn to identify pre-syncope symptoms and take immediate action
  • Using counter-pressure maneuvers: Techniques like leg crossing, muscle tensing, or squatting can help prevent fainting when feeling dizzy

When Medicine Matters: Pharmacological Treatment for Syncope

While medication is not commonly prescribed for vasovagal syncope in children and adolescents, there are instances where pharmacological intervention may be necessary. This is typically reserved for cases where lifestyle modifications and preventive measures have proven ineffective in managing symptoms.

What medications might be used to treat recurrent syncope?

In some cases, a healthcare provider may recommend:

  • Beta-blockers: To regulate heart rate and blood pressure
  • Fludrocortisone: To increase blood volume and pressure
  • Midodrine: To constrict blood vessels and increase blood pressure
  • Selective serotonin reuptake inhibitors (SSRIs): To help regulate the nervous system’s response

It’s important to note that medication use for syncope in young people is individualized and should only be initiated under close medical supervision.

Beyond Vasovagal: Other Causes of Syncope in Young People

While vasovagal syncope is the most common cause of fainting in children and adolescents, it’s essential to be aware of other potential causes. These may require different diagnostic approaches and treatment strategies.

What other conditions can cause syncope in young people?

Less common causes of syncope in children and adolescents include:

  1. Orthostatic hypotension: A sudden drop in blood pressure upon standing
  2. Neurological conditions: Such as migraines or certain types of seizures
  3. Metabolic disorders: Including hypoglycemia or electrolyte imbalances
  4. Psychological factors: Such as panic attacks or anxiety disorders
  5. Medication side effects: Certain medications can cause dizziness or fainting

Understanding these potential causes highlights the importance of a thorough medical evaluation to determine the underlying reason for syncope and ensure appropriate treatment.

Empowering Patients and Families: Education and Support for Syncope Management

Dealing with recurrent syncope can be challenging for both patients and their families. Education and support play crucial roles in managing the condition effectively and reducing anxiety associated with fainting episodes.

How can families best support a child with recurrent syncope?

To help manage syncope and its impact on daily life:

  • Learn about the condition: Understand the causes, triggers, and management strategies for syncope
  • Communicate openly: Encourage your child to talk about their symptoms and concerns
  • Create a safe environment: Identify potential hazards at home and school to prevent injuries during fainting episodes
  • Develop an action plan: Work with healthcare providers to create a plan for managing symptoms and responding to fainting episodes
  • Educate others: Inform teachers, coaches, and caregivers about your child’s condition and how to respond
  • Join support groups: Connect with other families dealing with syncope for shared experiences and advice
  • Monitor progress: Keep a symptom diary to track frequency and potential triggers of fainting episodes

By taking a proactive approach to syncope management, families can help their children lead normal, active lives while minimizing the impact of this common condition.

Fainting (Syncope) | Symptoms, Diagnosis & Treatment


Why Do Children & Teenagers Faint (Syncope)?

Fainting (syncope) is common during childhood in healthy adolescents and young adults. Around 20 percent of young adults report having fainted at least one time.

Despite being common, fainting can cause a great deal of worry for patients and their caregivers. This is often due to the fear that those who faint are at risk for sudden death.

Symptoms

Dizziness, muffled hearing and visual changes (such as “blacking out”) often happen before fainting. Many patients complain of these symptoms without syncope. It is more common to have these symptoms when it is hot or when changing positions from sitting or lying down to standing.

Causes of Syncope

Fainting (syncope) is caused by a sudden decrease in blood pressure. For a moment, the brain does not have the needed amount of oxygen. Syncope is only one reason someone can faint. Other reasons for fainting in children and adolescents are much less common. These reasons can often be figured out through a detailed history and an exam by their doctor. Some uncommon causes for fainting in children and adolescents are heart (cardiac) problems, seizures or other neurologic problems, and stress.

Fainting caused by heart issues during childhood is rare. Though rare this causes the most concern, because the cardiac cause can be life-threatening. There are a wide range of treatment options for many heart issues though.

Cardiac-Related Causes of Syncope
  • Cardiac causes can be secondary to blockage of blood flow (aortic valvar stenosis, hypertrophic cardiomyopathy, primary pulmonary hypertension, Eisenmenger’s syndrome).
  • Abnormal heart rhythms (ventricular tachycardia, Wolff-Parkinson-White syndrome, long QT syndrome, sinus node dysfunction, atrioventricular block, catecholaminergic polymorphic ventricular tachycardia)
  • Reduced heart function (ventricular dysfunction from dilated cardiomyopathy; inflammatory diseases such as acute myocarditis and Kawasaki disease; and ischemic heart disease secondary to an anomalous coronary artery, Kawasaki’s disease, or hypercholesterolemia)
Vasovagal Syncope or Neurocardiogenic Syncope

The most common cause of syncope during childhood is vasovagal syncope or neurocardiogenic syncope. These account for more than 90 percent of fainting in childhood. This problem is caused by:

  • Changes in the normal involuntary (autonomic) reflex. This leads the blood vessels to relax (vasodilation) when they should not.
  • In some, the heart rate lowers (bradycardia) at a time when the blood vessels should constrict and the heart rate should increase.

These changes result in a low blood pressure (hypotension). This leads to dizziness and fainting.

This problem is common and non-life threatening. Most children and adolescents with this problem can be treated with aggressive hydration (70-80 ounces of fluid per day), an increase in salt in their diet, and watching their symptoms (sitting or lying down if they feel dizzy).

When Should Someone Who Has Passed Out See a Cardiologist?

Most healthy children and adolescents who have fainted are checked out by their primary care doctor. Some of the red flags that should lead to seeing a heart doctor include:

  • Fainting that happens with exercise
  • Fainting that happens without warning (no dizziness, muffled hearing or visual changes)
  • Fainting that results in severe injury
  • A family history of sudden unexplained death, cardiomyopathy or congenital heart disease
  • An abnormal cardiac exam or ECG

Testing and Diagnosis

A cardiologist will decide if a patient’s fainting and/or dizziness has a life-threatening cause.

The key part of the exam is the detail the patient gives of their symptoms (history).

Both cardiac and neurologic causes of fainting can often be ruled out with a good history and physical exam.

An electrocardiogram (ECG) will often be done to screen for abnormal heart rhythms.

Sometimes, other tests will be done such as an echocardiogram, graded exercise test (GXT) and / or electroencephalogram (EEG).

Also, some patients will have a tilt table study. During this test, the patient is strapped to a table and tilted to near standing. This is done to provoke the common, non-life threatening, form of syncope.

Lifestyle Changes

Neurocardiogenic syncope can often be treated without medicine. This can include:

  • Avoiding things that may provoke fainting
  • Avoiding caffeine
  • Increasing salt intake
  • Staying well hydrated. Fluid intake should be increased to the point that the urine is clear.

Certain movements can also be done to keep dizziness from leading to fainting. This can include:

  • Lying down
  • Squatting tensing the stomach muscles
  • Crossing the legs at the ankles
  • Placing one foot on a stool or chair while the other foot stays on the ground
Medicine

It is not common to need medicine for fainting. In the very small number of children and adolescents who need medicine there are two main medicines that are used.

Children with neurally mediated syncope most often use Florinef and Midodrine.

  • Florinef works by helping the kidneys hold in fluid and salt. Rare side effects include slight weight gain, very high blood pressure and leg cramping. Leg cramping is caused by low potassium. Patients on Florinef should increase their potassium intake with a well-balanced diet. They should be sure to eat enough fruit (bananas) and veggies.
  • Midodrine works by constricting the blood vessels and raising the blood pressure. Side effects include high blood pressure.

Outlook

Most patients with neurally mediated syncope will outgrow their symptoms. This may take several years though.

Patients who are fainting despite these measures can be seen in our Syncope Clinic. Referrals can be made through your primary doctor.

Last Updated 10/2021

Reviewed By Jeffrey Anderson, MD, MPH, MBA

The Heart Institute has more than 30 outpatient heart locations in Ohio, Kentucky and Indiana.

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Fainting – Better Health Channel

Summary

Read the full fact sheet

  • Common causes of fainting include heat, pain, distress, the sight of blood, anxiety and hyperventilating.
  • Lying the person down will often improve the person’s condition.
  • Frequent fainting spells need to be medically investigated to check for underlying causes.

What is fainting?

Fainting is a brief episode of unconsciousness caused by a sudden drop in blood pressure. The most likely cause of this sudden drop will either be some change in the blood vessels or the heartbeat itself.

Blood vessels continually adjust their width to ensure a constant blood pressure. For instance, the vessels constrict (tighten) when we stand up to counteract the effects of gravity. Temporary low blood pressure can be caused by various events that prompt blood vessels to dilate (expand), including extreme heat, emotional distress or pain. The lack of blood to the brain causes loss of consciousness.

Most fainting will pass quickly and won’t be serious. Usually, a fainting episode will only last a few seconds, although it will make the person feel unwell and recovery may take several minutes. If a person doesn’t recover quickly, always seek urgent medical attention.

Symptoms of fainting

The symptoms of a faint include:

  • dizziness
  • light-headedness
  • a pale face
  • perspiration
  • heightened anxiety and restlessness
  • nausea
  • collapse
  • unconsciousness, for a few seconds
  • full recovery after a few minutes.

Occasionally, a collapse may be caused by a more serious event such as a stroke or a disturbance in the normal heart rhythm. A faint might be telling you something is wrong and further examination is sometimes important.

If a person complains of breathlessness, chest pains or heart palpitations, or if the pulse is faster or slower than expected, call triple zero (000). Similarly, slurred speech, facial droop or weakness in any limbs are signs of a serious problem.

Causes of a drop in blood pressure

A temporary drop in blood pressure can be caused by different factors, including:

  • prolonged standing
  • extreme heat, which pushes blood away from the main circulatory system and into the vessels of the skin
  • emotional distress
  • severe pain
  • the sight of blood
  • the sight of a hypodermic needle
  • other events that a person may find distressing.

What to do if you feel faint

If you feel faint, lie down and elevate your feet.

This may prevent a loss of consciousness. Fresh air can also help, especially if you are feeling hot.

If it is not possible to lie down, put your head down as low as possible.

If you do faint, remain lying down for 10 minutes. Sit up slowly when you need to get up.

First aid and fainting

First aid treatment for a person who has fainted includes:

  • Help the person lie down. A person who has fainted in a chair should be helped to the ground.
  • If the person is unconscious, roll them on their side. Check they are breathing and that they have a pulse. If they are not breathing or do not have a pulse, call triple zero (000) and begin CPR.
  • If possible, elevate the person’s feet above the height of their head.
  • If the fainting episode was brought on by heat, remove or loosen clothes, and try to cool the person down by wiping them with a wet cloth or fanning them.
  • Assess the person for any potential injuries if they have fallen.
  • In an emergency, always call triple zero (000) for an ambulance if the person has not regained consciousness within a few seconds or recovered in a few minutes.

Hypotension and fainting

Low blood pressure (hypotension) is a condition characterised by blood pressure that is lower than normal or usual for the person.

Hypotension can be caused by a variety of factors including:

  • heart disease and abnormal heart rhythms
  • some infections
  • dehydration
  • medications for high blood pressure or certain heart conditions.

Low blood pressure can also be caused by a rare disorder of the adrenal glands called Addison’s disease.

Frequent fainting spells or sensations of light-headedness need to be medically investigated to check for underlying causes.

Orthostatic hypotension

Blood vessels respond to gravity by constricting (tightening). This increases or maintains blood pressure when we stand up from a sitting or lying position.

Orthostatic hypotension means that the blood vessels don’t adjust to a standing position, but instead allow the blood pressure to drop, which can trigger a fainting episode. For this reason, some people, particularly the elderly or those on blood pressure medication, should stand up from sitting or lying in bed slowly. This helps prevent fainting after sudden changes in position.

Causes of orthostatic hypotension include:

  • nervous system diseases, such as neuropathy
  • prolonged bed rest
  • dehydration
  • irregular heartbeat (heart arrhythmia)
  • changes in blood pressure medication.

Where to get help

  • In an emergency, always call triple zero (000)
  • Your GP (doctor)

  • FaintingExternal Link, St John Ambulance Australia.
  • Fainting: first aidExternal Link, Mayo Clinic.
  • Low blood pressureExternal Link, Medical Online.

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causes, types, symptoms, signs, diagnosis, first aid, treatment

Causes

Classification

Symptoms

Diagnosis

Treatment

Fainting (from the Latin “syncope”) is a state of short-term loss of consciousness that occurs as a result of impaired cerebral circulation. The duration of a person’s stay in an unconscious state ranges from a few seconds and can reach up to one minute. In the case of a deep blackout of consciousness, the time increases to several minutes.

Clinical manifestations consist of precursors, an unconscious period, followed by a recovery stage, accompanied by weakness, dizziness, and a drop in blood pressure.

Reasons

Physiologically, the speed of blood movement through the vessels of the brain is from 60 to 100 ml per 100 g of brain matter per minute. In the case of a sharp decrease in blood flow to 20 ml, after a few first seconds, a state of fainting occurs.

A decrease in the speed of blood movement in the vessels of the head is often caused by:

  • decreased blood output;
  • narrowing of the arterial lumen;
  • violation of the nervous regulation of blood vessels.

Fainting is a fairly common pathology throughout the world. The risk of developing a short-term blackout is the same for both women and men.

Moreover, fainting in children is much less common than in adults. People over the age of 80 are at increased risk, as they are more likely to suffer from cardiovascular pathology.

Classification

There are several options for systematizing fainting. Most are based on the etiopathogenetic principle. Thus, they distinguish:

  1. Neurogenic type. This category includes vasovagal and irritative states.
  2. Orthostatic syncope. This group includes conditions caused by vegetative insufficiency, a decrease in circulating blood volume, an orthostatic decrease in pressure induced by medication.
  3. Cardiogenic type. Fainting develops as a result of impaired functioning of the heart and blood vessels.
  4. An arrhythmogenic type of blackout can be triggered by arrhythmia, a side effect of antiarrhythmic drugs.
  5. Cerebrovascular (dyscirculatory) type of syncope. Loss of consciousness may be a consequence of the pathology of the vessels of the head.
  6. Atypical syncope is a condition in which the precipitating factor is unknown.

Symptoms

The maximum state of syncope can last no more than half an hour, but more often it does not exceed 3-4 minutes. Even in this case, syncope occurs in 3 stages:

  1. Harbingers (presyncope).
  2. Actually fainting.
  3. Recovery.

The duration and symptoms of each stage of fainting can manifest themselves in different ways and directly depend on the cause that provoked the development of this condition.

Harbingers

The duration of the precursor period is only a few minutes or even seconds. Signs of fainting harbingers:

  • sudden increase in weakness, feelings of dizziness;
  • appearance of dizziness;
  • eclipse in the eyes;
  • feeling short of breath.

If a person does not have the opportunity to lie down quickly, then with an increase in symptoms, he will fall and lose consciousness.

In the case of a slow development of the presyncope state, the patient will avoid injury if, when falling, he can hold onto the surrounding objects. The rapid development of precursors often causes serious injuries.

Syncope itself

This period is characterized by loss of consciousness of varying depth. The breath of a fainted person becomes superficial, and the muscles completely relax. When examining an unconscious person, a slow reaction of the pupils to light is noted, the pressure during fainting is below normal. The pulse of a person who is in a state of syncope becomes weak. But tendon reflexes persist.

Syncope, accompanied by a deep loss of consciousness with obvious signs of hypoxia, as a rule, is manifested by convulsions, as well as involuntary excretion of urine.

Post-syncope

The recovery phase after an attack can last up to one to two hours. A person complains of weakness, dry mouth and dizziness. Paleness of the skin, severe sweating are visually noted. Blood pressure is below normal, there is uncertainty of movements.

As a rule, a person remembers very well everything that happened before he lost consciousness. This feature makes it possible to exclude the negative consequences of fainting, such as the presence of TBI, which is characterized by the manifestation of retrograde amnesia. Clinical manifestations of different types of syncope may differ.

Vasovagal syncope

This is the most common type of brief blackout. The mechanism of development of syncope is associated with a sudden onset, peripheral vasodilation. As a provocateur, as a rule, are being in a stuffy room, standing for a long time, stress, overheating of the body, pain.

Vasovagal syncope occurs when the person is standing or walking. If, with the appearance of harbingers, it is possible to lie down or leave the zone of discomfort, which is the cause of fainting, then everything can be limited to the stage of harbingers.

The vasovagal type of loss of consciousness is characterized by the presence of the following stages:

  1. The precursor stage lasts up to three minutes. During this time, a person manages to notify others that he feels unwell.
  2. Actually fainting: the time of this state is 1-2 minutes. At this stage, pallor of the skin is noticeable, there is a decrease in muscle tone, a drop in blood pressure.
  3. The post-syncope stage is characterized by weakness that lasts from five minutes to an hour.

Cerebrovascular

Usually, cerebrovascular syncope occurs when there are problems in the cervical segment of the spinal column. As a result of a sharp turn of the head, compression of the vertebral artery occurs and cerebral ischemia develops, which leads to loss of consciousness.

Irritative syncope

The manifestation of this type of syncope can occur in the presence of pathology from the digestive organs.

Loss of consciousness can be triggered by pain, swallowing, gastroscopy procedure. The warning period usually lasts a few seconds. The person is in a faint from one to two minutes.

Cardiogenic and arrhythmogenic

These pathologies can be the first symptoms of myocardial infarction, which complicates the diagnosis of the underlying disease. The features of syncope can be cardiogenic collapse, a deep degree of blackout, a recurrence of an attack when a person tries to get up.

Orthostatic

An attack of orthostatic syncope can develop in the morning while getting out of bed. The condition is typical for people suffering from hypotension, after surgery, the elderly. Usually they often complain of the appearance of dizziness or blackout in the eyes when standing up abruptly.

Diagnosis

Examination and diagnosis are carried out in several stages.

The first step in the diagnosis is a survey and examination. To make a correct diagnosis, the doctor needs to know the reasons that could cause syncope. First of all, the specialist must exclude pathologies (bleeding, myocardial infarction) that can provoke loss of consciousness. In the presence of diseases of the heart and blood vessels, it is necessary to undergo treatment with a cardiologist.

Next, you need to find out if the person suffers from any organic brain damage. In this case, you will need to visit a neurologist, and if there is a tumor, an oncologist.

The initial appointment is usually made by a neurologist or internist, and also by a pediatrician (if the patient is a child). But also in some cases, the opinion of other specialists may be required:

  • a psychiatrist if the patient suffers from epilepsy;
  • cardiologist – in the presence of a pathology of the heart;
  • endocrinologist – with an increase in blood sugar.

Conducting laboratory research. Blood tests, as well as the patient’s urine, help find the cause of fainting. Blood is examined for biochemistry, gas composition, sugar content. Carry out a glucose tolerance test.

Examination of the patient includes studies of cardiac activity, the state of blood vessels, brain activity, depending on the alleged pathology.

If it is difficult to determine the mechanism of syncope, a tilt test is used.

Treatment

In case of fainting, first aid measures are reduced to creating conditions that improve the flow of oxygen to the head. For this, a person is laid in such a way that there are no restrictions on the flow of fresh air, the collar is unbuttoned, if there is a tie, it is weakened. A cotton swab dipped in ammonia is brought to the nose of the victim, and cold water is splashed on the face.

If there is no effect, call an ambulance immediately. If a cardiac arrest occurs, then before the arrival of the ambulance, it is necessary to do an indirect heart massage.

It is important to know that in the event of even a single episode of loss of consciousness, one should not ignore the appeal to a doctor. In order for a specialist to establish the cause that provoked syncope, you will need to undergo a comprehensive examination. In any case, the methods of treating fainting will be aimed not only at eliminating the problem, but also its causes.

The author of the article:

Ivanova Natalya Vladimirovna

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