As an ER pediatrician, it’s fairly common to see children and teens who have fainted and have come to the emergency department to find out what triggered this scary experience. Passing out can be a sign of a serious health problem, but in young people there’s usually little cause for concern and we can help them avoid another episode.
A temporary loss of consciousness and muscle tone that resolves without medical intervention is commonly known as fainting or passing out—and in the Southern U.S., as “falling out.” The medical term for this is syncope, pronounced: sing-kuh-pee. Syncope may occur when the brain isn’t getting enough blood flow or energy (glucose).
Fainting occurs in about 50 percent of all people at some time for a variety of reasons. About 40 percent of first-time episodes occur before adulthood, most commonly in girls in their late teens.
When an adult faints, it’s more likely due to a heart or cardiac problem. With kids, there’s usually a much less serious explanation.
Let’s look at the most common scenario. A teenage girl arrives at the ER alert and feeling fine. A short time earlier, she was standing in choir class, had not eaten breakfast and suddenly began to feel dizzy, warm or nauseated (or all three). Then everything went black. The next thing she remembers, she was lying on the floor surrounded by her classmates. They told she looked pale and fainted for a few seconds.
This is “reflex syncope,” which accounts for 75 percent of childhood fainting cases. It usually occurs when a young person is standing and blood pools in the legs. This causes somewhat decreased blood return to the heart and lower-than-normal blood pressure, resulting in decreased blood flow to the brain. A young person may be somewhat dehydrated when this occurs, since many teens frequently don’t drink enough fluids.
How it’s diagnosed
What do we do in the ER? The events leading up to syncope usually are the key to a diagnosis. Reflex syncope is likely if the teen:
- Has symptoms prior to fainting that last a few seconds to a minute. These could include dizziness, feeling warm, nausea, sweating, vision changes and a sense of an irregular heartbeat.
- Has a good memory of events
- Returns to normal alertness in less than a minute
A physical exam and an electrocardiogram that turn out normal can confirm a diagnosis of reflex syncope. No further testing is needed and we will advise the teen to:
- Drink more fluids and increase salt intake, especially early in the day
- Don’t to skip meals
- Exercise regularly
- Avert another episode of fainting if early symptoms occur by lying down with feet up and contracting muscles in the legs and arms to increase blood flow.
Remember that syncope ends quickly and without the need for medical care. And if a young person follows treatment advice, syncope is less likely to occur again.
Other triggers for reflex syncope include the sight of blood and sudden, acute pain or fear. Did you know that even babies sometimes faint? Children 6 months to six years may hold their breath until they pass out when they are angry, upset or in pain, then quickly regain consciousness. This behavior is typically called breath-holding spells, but it’s also a type of reflex syncope.
What to do if someone faints
When someone faints, lower them to the ground, put their feet up and expect them to awaken quickly. Don’t hold the person up in a standing or sitting position. This will delay the return of blood flow to the brain and delay recovery.
Once awake, and if back to normal, a child should drink extra fluids. Next, contact his or her doctor for an appointment or go to the ER. Most people can’t check blood pressure or do electrocardiograms at home, so let us take care of that. If the child has fainted before (and about half of pediatric patients have more than one episode of syncope), a doctor may tell the patient or parent that it’s OK to stay home.
When to be concerned
You will need to see a doctor if your child:
- Passes out with no symptoms beforehand
- Faints while actively exercising. It is more common and not too worrisome for someone to pass out after exercising, however.
- Loses consciousness with a loss of pulse, or requires CPR or defibrillation to be revived
- Has a history of heart problems or congenital deafness
- Had a relative under 50 who died of a cardiac condition or for unexplained reasons
- Has a relative with cardiomyopathy, long QT syndrome or who needs an implanted defibrillator
- Doesn’t wake up quickly, alert and responding appropriately, within one to two minutes after fainting
If any of these circumstances apply, your child may need further evaluation by a cardiologist in a timely manner. Again, come to the ER or see your doctor as soon as possible in these circumstances.
If you have questions or concerns about your kids and any unusual fainting, call your provider at 206-215-2700 to schedule an appointment.