The evaluation and management of syncope in children

ABSTRACT

Syncope or reversible loss of consciousness is common in children, experienced by about 20 percent of the paediatric population at least once, and accounts for about 6 percent of hospital admissions. The evaluation of these patients may be expensive and unrewarding. Their symptom complex arouse extremes anxiety, for the most part unwarranted, in family, friends, teachers and physicians, resulting in restriction in activity. The most common cause of syncope in this population is neurally medicated, a benign condition which can often be easily treated by reassurance, situational avoidance and simple medication to augment cardiac output and/or to blunt the responsible neural reflex. Occasionally, syncope may be a manifestation of a serious or life threatening cardiac disorder, which requires more in depth evaluation and treatment to reduce the symptoms and the risk of sudden death. A stepwise approach to evaluation can categorize these patients to avoid unnecessary expense and anxiety while at the same time recognising the more serious cardiac disorders. A careful history of the episodes, family history and physical examination, together with a 12 lead electrocardiogram, may be all that is necessary to evaluate a simple faint. With more complex symptoms, especially with recurrence, a head up tilt examination is useful. More detailed evaluation can be reserved for those for whom there is a high index of suspicion based on their previous results. This common sense approach to the evaluation of syncope could allay anxiety and reduce physical activity restrictions and costs in an already economically exhausted care system.(AU)