SYMPOSIUM ON PGIMER PROTOCOLS ON NEUROLOGICAL EMERGENCIES Fainting Attacks in Children Kirti M. Naranje & Arun Bansal & Sunit C. Singhi Received: 12 May 2011 /Accepted: 1 June 2011 /Published online: 22 June 2011 # Dr. K C Chaudhuri Foundation 2011 Abstract Fainting attack or syncope in children is a common occurrence, with vasovagal syncope being the commonest cause for majority of pediatric syncope. The aim of emergency room evaluation is not to miss the rare serious underlying disorder causing syncope. A complete detailed history of the event followed by physical exami- nation helps in categorising syncope into the three major categories—neurally mediated, cardiovascular and non cardiovascular syncope. Investigations will remain normal in majority of the cases. A 12-lead ECG and standing test should be done in all the cases which helps in establishing the cause for syncope. Management varies depending upon the cause and majority of them do not require hospital admission. Keywords Syncope . Standing test . Head up tilt test . Vasovagal syncope Introduction Fainting or syncope is a common clinical problem in children and adolescents, with as many as 15% of children experiencing at least one episode of syncope before the end of adolescence. The overall incidence in children is 0.1– 0.5% and constitutes 1–3% of emergency visits [1]. The vast majority of episodes of syncope are benign and only a minority are caused by something potentially more serious or even life threatening. Definition Syncope is defined as transient loss of consciousness and postural tone caused by reduced cerebral perfusion. It is characterized by sudden onset loss of consciousness because of a lack of cerebral blood flow; falls of the patient if he or she is not supported; and transient attacks [2]. Etiology Most children presenting to emergency department have a benign cause for syncope; the commonest being vasovagal syncope. Common causes of syncope can be broadly divided into three major categories (Table 1). Evaluation The aim of emergency evaluation is not to miss the rare occurrence of serious underlying disorder in a child with syncope and to differentiate syncope from seizures (Table 2). A thorough clinical evaluation, including history and physical examination is the first step in identifying the three major categories of syncope (Tables 3 and 4). Laboratory Investigations Laboratory investigations for syncope in childhood will almost always be normal; the key to the diagnosis is a detailed and careful history. A 12-lead ECG is required in all children with syncope with special emphasis on the K. M. Naranje : A. Bansal : S. C. Singhi (*) Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India e-mail: sunit.singhi@gmail.com Indian J Pediatr (March 2012) 79(3):362–366 DOI 10.1007/s12098-011-0497-7