Causes of fainting in childhod

1. Big picture

Fainting in childhood usually means syncope: a brief, sudden loss of consciousness caused by transient reduction of blood flow to the brain, followed by spontaneous complete recovery.

Most pediatric fainting is benign vasovagal syncope, especially in adolescents. But the exam priority is to identify the dangerous minority:

Syncope during exercise, syncope while supine, palpitations before collapse, chest pain, abnormal ECG, abnormal cardiac examination, or family history of sudden death = cardiac syncope until proven otherwise.

The examiner wants a structured answer:

1. Confirm it was true transient loss of consciousness.
2. Differentiate syncope from seizure, hypoglycemia, breath-holding spell, intoxication, and psychogenic events.
3. Search for red flags of cardiac disease.
4. Do ECG in every child with unexplained syncope.
5. Treat benign vasovagal syncope with education, fluids, salt, trigger avoidance, and counter-pressure maneuvers.

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