Neurocardiogenic Syncope, Child

ExitCare ImageNeurocardiogenic syncope (NCS) is the most common cause of fainting in children. It is a response to a sudden and brief loss of consciousness due to decreased blood flow to the brain. It is uncommon before 10 to 12 years of age.

CAUSES

NCS is caused by a decrease in the blood pressure and heart rate due to a series of events in the nervous and cardiac systems. Many things and situations can trigger an episode. Some of these include:

  • Pain.

  • Fear.

  • The sight of blood.

  • Common activities like coughing, swallowing, stretching, and going to the bathroom.

  • Emotional stress.

  • Prolonged standing (especially in a warm environment).

  • Lack of sleep or rest.

  • Not eating for a longtime.

  • Not drinking enough liquids.

  • Recent illness.

SYMPTOMS

Before the fainting episode, your child may:

  • Feel dizzy or light-headed.

  • Sense that he or she is going to faint.

  • Feel like the room is spinning.

  • Feel sick to their stomach (nauseous).

  • See spots or slowly lose vision.

  • Hear ringing in the ears.

  • Have a headache.

  • Feel hot and sweaty.

  • Have no warnings at all.

DIAGNOSIS

The diagnosis is made after a history is taken and by doing tests to rule out other causes for fainting. Testing may include the following:

  • Blood tests.

  • A test of the electrical function of the heart (electrocardiogram, ECG, EKG).

  • A test used check response to change in position (tilt table test).

  • A test to get a picture of the heart using sound waves (echocardiogram).

TREATMENT

Treatment of NCS is usually limited to reassurance and home remedies. If home treatments do not work, your child's caregiver may prescribe medicines to help prevent fainting. Talk to your caregiver if you have any questions about NCS or treatment.

HOME CARE INSTRUCTIONS

  • Teach your child the warning signs of NCS.

  • Have your child sit or lie down at the first warning sign of a fainting spell. If sitting, have them put their head down between their legs.

  • Your child should avoid hot tubs, saunas, or prolonged standing.

  • Have your child drink enough fluids to keep their urine clear or pale yello and have them avoid caffeine. Let your child have a bottle of water in school.

  • Increase salt in your child's diet as instructed by your child's caregiver.

  • If your child has to stand for a long time, have them:

  • Cross their legs.

  • Flex and stretch their leg muscles.

  • Squat.

  • Move their legs.

  • Bend over.

  • Do notsuddenly stop any of their medicines prescribed for NCS.

Remember that even though these spells are scary to watch, they do not harm the child.

SEEK MEDICAL CARE IF:

  • Fainting spells continue in spite of the treatment or more frequently.

  • Loss of consciousness lasts more than a few seconds.

  • Fainting spells occur during or after excercising, or after being startled.

  • New symptoms occur with the fainting spells such as:

  • Shortness of breath.

  • Chest pain.

  • Irregular heart beats.

  • Twitching or stiffening spells:

  • Happen without obvious fainting.

  • Last longer than a few seconds.

  • Take longer than a few seconds to recover from.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Injuries or bleeding happens after a fainting spell.

  • Twitching and stiffening spells last more than 5 minutes.

  • One twitching and stiffening spell follows another without a return of consciousness.