What You Should Know About Fainting in Children

Fainting (syncope) in children is surprisingly common. In this Q&A, pediatric epilepsy expert Ajay Gupta, MD, explains what parents should watch for, the differences between fainting and seizures and six ways to prevent syncope in children.

Q. What is fainting (syncope) in children?

A. Syncope, pronounced “SIN-ko-pea,” is the medical term for fainting. When a child faints, the blood supply — and the oxygen that blood brings to the brain — is temporarily reduced. This causes the child to lose consciousness, sometimes fall, and in severe cases, have a short seizure.

Syncope typically occurs in children during their pre-teen and teen years. It can also happen earlier, but that’s less common.

Children usually outgrow syncope. Most teens have no significant disability or restrictions from it.

Q. Why would a child pass out?

A. Kids faint because of the reduced blood supply to their brain. Triggers for this reduction in blood supply include:

• Dehydration.
• Medications.
• Not eating properly.
• Sickness.
• Standing too long.
• Rarely, heart disease or other diseases can cause recurrent syncope.

There are also rare types of syncope where kids faint when they:

• Have severe constipation.
• Try to pee.
• Try to stretch.
• Experience emotional or physical pain.

When a child faints, it’s usually due to several factors. For example, let’s say a teen who’s already thin and didn’t sleep well at night. In the morning, he doesn’t eat or drink anything, goes to school and stands in line for some project. It’s hot, so he sweats a little bit, and then the teacher shows his class some biology experiment that’s a little scary.

That’s a perfect scenario for a fainting spell. It’s usually multiple things combined that lead to fainting.

Q. How common is syncope in children?

A. Some estimates say 20% of children will experience at least one fainting episode before adolescence ends. Syncope is a common reason why children faint or feel dizzy. But it’s underdiagnosed. Near syncope and mild syncope, less severe types of syncope, often go unnoticed until the child ends up in the emergency room after a bigger event.

Q. What makes a child prone to fainting?

A. Some children are genetically more prone to fainting than others. For example, research has connected some types of neurocardiogenic syncope to genes. It’s the most common cause of fainting in children.

Neurocardiogenic syncope (vasovagal syncope) in children is when they faint because their body overreacts to something that distresses them. Their experience and emotions cause the brain to send a signal to the heart, causing the heart to start pumping slowly. Then their blood pressure drops, the brain blood supply drops, and they drop.

Vasovagal syncope can happen when a child watches a movie with some blood, violence or other scary visual. Some kids pass out when they go to the doctor’s office to get an immunization or blood test. That’s enough for them.

There are many genetic factors, but usually environmental factors affect these vulnerable children as well. But some can avoid syncope by following good precautions.

Q. What are the signs that your child is going to faint?

A. Signs that your child may be about to faint include:

• Dizziness.
• Nausea.
• Feeling like the world is spinning, or everything is black or blurred.
• Sense of doom.
• Sounds begin to appear muffled.

They may even say, “I’m going to pass out.”

Q. When does fainting lead to seizure?

A. Syncope has a spectrum:

• Near syncope is when a kid says, “I’m dizzy,” and almost faints but doesn’t.
• Mild syncope is when the child says, “I don’t feel good. I feel dizzy.” The child may be close to fainting, but sitting, laying down or drinking water prevents it from happening.
• Full syncope happens if the reduction in blood supply and oxygen is severe and lasts longer. The child may fall and be unresponsive for a few seconds. They may even have a convulsion, when their muscles contract, causing the body to move uncontrollably. It takes several minutes to recover from full syncope.

If a seizure does happen, it’s typically short and does not become anything complicated. If these children learn how to take care of themselves to avoid fainting, they won’t have another seizure.

Q. What is the difference between severe fainting spells and a seizure disorder?

A. Anyone who loses blood and oxygen supply to the brain can have seizures. But these seizures tend to be short, and children recover quickly. They won’t have any symptoms following the seizure. They also won’t have another seizure during the same episode.

But when a child has seizures that occur habitually and out of the blue, we often diagnose them with epilepsy (seizure disorder). Seizure disorders have nothing to do with blood supply and brain oxygenation. In this condition, a portion of the brain is irritated and fires rapidly, outside of its normal patterns.

The type of seizure depends on which part of the brain is firing abnormally. For example, if the seizure involves the right side of the brain, the child may have jerks on the left side of their body. If the seizure comes from the back of the brain on the right side, the child might have symptoms involving vision on the left side.

Q. How are seizure disorders and syncope diagnosed?

A. The child’s medical history is critical. So is their environment. We go over these details, do a physical exam and find out if they have any risk factors for epilepsy.

Finally, if we’re still not sure, these diagnostic tests can help:

• Electroencephalogram (EEG), which measures the brain’s electrical activity.
• Electrocardiogram (EKG), which records the heart’s electrical activity.

Before we say it’s syncope, we have to make sure their heart is OK. There could be an undiagnosed heart rhythm disorder or structural defect. Similarly, we have to rule out seizures and other neurological conditions before we say it’s syncope.

Q. How can you prevent fainting in children?

A. These six tips can prevent syncope in children:

• Stay hydrated: Good hydration leads to good blood volume in the body. Then blood can more easily supply the brain with oxygen. The brain is the highest part of your body. If you’re standing, you need a lot of force to supply the brain with blood. It works like a pump: If you’re pumping water to the top floor, you need more volume and pressure.
• Get enough salt: Adequate salt helps because salt expands blood volume and increases blood pressure. But that doesn’t mean they have to eat a teaspoon of salt. Instead, children can have a salty snack. Or if they’re exercising, they should drink a sports drink with electrolytes and salt in it.
• Eat regularly: Breakfast is an especially important meal. It should have some sugar and protein so that their blood sugar doesn’t drop too low.
• Wear compression socks: Compression socks help pump the blood from the legs up to the brain.
• Be aware of signs of syncope: Teach children that getting dizzy could be a sign of upcoming syncope. So they should sit down to help prevent it.
• Learn counter-pressure techniques: Certain body movements can help stop kids from fainting. They are known as counter-pressure techniques or syncope maneuvers. For example, kneeling and flexing the muscles around your knees and hips temporarily stops the blood supply going to this area. This makes more blood available for the brain.

Q. When should you see a doctor about kids fainting?

A. If they lose consciousness from fainting, a seizure or anything else, they should see a doctor. It’s never normal for a child to lose consciousness without reason. We should see every child at the time of their first symptoms, so we can evaluate them and make a plan, depending on the severity of the condition.

Treatments for syncope and seizures are very different. So it’s important for doctors to do their due diligence, including the proper follow-up, examinations and testing when needed. You want the earliest possible diagnosis of epilepsy so you can start treatment.