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Emergency evaluation of syncope in children and adolescents

Jack C Salerno, MD
Section Editors
George A Woodward, MD
John K Triedman, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review the serious and benign causes of syncope.

The causes of syncope in children and the evaluation of adults with syncope are discussed separately. (See "Causes of syncope in children and adolescents" and "Approach to the adult patient with syncope in the emergency department".)


Syncope is a sudden, brief loss of consciousness associated with loss of postural tone from which recovery is spontaneous [1]. Approximately 15 percent of children experience a syncopal episode prior to the end of adolescence [2].

Syncope is a symptom that can be classified according to the underlying cause: autonomic (eg, vasovagal [neurocardiogenic], situational, and orthostatic syndromes), cardiac, metabolic, or a condition that mimics syncope (table 1). Based upon case series of pediatric patients evaluated in the emergency department setting, autonomic forms comprise up to 80 percent of cases [3-6]. Neurologic etiologies, such as seizures or migraine headaches, are present in up to 20 percent of patients. Life-threatening conditions such as hypoglycemia, heat illness, anaphylaxis, cardiac arrhythmia, or structural cardiac disease are relatively rare but occur frequently enough (1 to 2 percent of children) to warrant diagnostic consideration.

Causes of syncope and paroxysmal conditions that mimic syncope are discussed in more detail separately. (See "Causes of syncope in children and adolescents" and "Nonepileptic paroxysmal disorders in infancy" and "Nonepileptic paroxysmal disorders in children".)

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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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