My Child Passes Out

Do you have a child who passes out?  Passing out/falling out/fainting, or what is medically termed syncope, commonly occurs in older children and adolescents. It is estimated that 1 in 3 people will have an episode of syncope during their lifetime and accounts for 3-5% of emergency room visits. It is more frequent in females than males. When syncope occurs in childhood and young adulthood, it is rarely life threatening, but can be quite a nuisance and cause significant anxiety.

So what causes syncope?

The vast majority of syncope is in the form of vasovagal or neurocardiogenic sycope and there are many other terms that could be used here to describe what I consider the simple fainting episode. When these occur, there is usually an inciting event. There are numerous types of inciting events and many times, it cannot be identified. Examples of these include standing up quickly, hair dressing, fright, locked legs in a closed room, blood drawing (venipuncture). This event causes a fall in the blood pressure, sometimes from blood pooling in the legs and can cause your child to pass out. Usually the body overcomes this blood pressure fall by increasing the heart rate and constricting the blood vessels. However, sometimes this compensatory mechanism goes awry. The brain doesn’t like the lower blood pressure and through complex signals, the heart rate falls and the blood pressure further falls. During this time, one feels dizzy and light headed with tunnel vision. People will also describe nausea and ringing in the ears. If this state persist, the brain will lose consciousness and the muscles will relax and the body will fall to the ground. The lower blood pressure is tolerated and the brain receives blood again and the symptoms resolve. This is often associated with stress and people will feel an increase in their heart rate and feel dizzy. The biggest risks in these events are getting hurt when one falls or being caught and forced to maintain an upright position.

Rarely, syncope can have cardiac causes, and these are important to keep in mind. These include electrical rhythm disturbances and structural problems that prevent the heart from pumping blood adequately. These problems present differently and we search for “red flags” that tell us to do a more detailed evaluation.

What do I do if my child passes out?

First, make sure they are ok. Keep them lying down – do not try to hold them up in a standing or sitting position.  Check their heart rate and breathing (if absent, call 911). Assuming these are ok, give them something to drink and make sure they are doing ok. Have them slowly get up when they are feeling better. Getting up too quickly can result in another episode.

It is advisable if this is the first time your child has passed out to contact your doctor. He or she might want to see you in clinic and perform and EKG and check basic labs to make sure these symptoms are not brought on from anemia or important dehydration. They should take a thorough history about the symptoms and look for red flags that would indicate cardiology referral.
These red flags include:

• Syncope with exercise
• Family history of:
  • Sudden death < 40 years, long qt syndrome
  • Arrhythmogenic Right Ventricular Dysplasia (ARVD)
  • congenital deafness
  • drowning episodes
  • single motor vehicle accidents
  • catecholaminergic polymorphic ventricular tachycardia (CPVT)
  • hypertrophic cardiomyopathy
  • etc
• Seizure activity
• Loss of bowel or bladder continence

Cardiology referral is necessary to attempt to rule out cardiac causes, but isn’t necessary to manage most fainting episodes. Your doctor might advise therapies that are effective in reducing symptoms. It is recommended that adult size people should drink over 80 ounces of water a day and adding electrolytes in form of salt (thermotabs) or some sports drinks can help. Medication therapy is rarely necessary or advisable in children and data to support its benefit is limited at best.