When fainting or dizziness in children needs medical attention

Parents should seek medical guidance if a child:

• Faints during exercise or sports
• Has chest pain or a racing heart
• Has repeated fainting or dizziness episodes
• Takes longer than expected to recover
• Has a significant head injury
• Has other unusual or concerning symptoms

Even if an episode seems mild, letting your child's pediatrician know can help determine whether the symptoms sound typical or need closer evaluation.

A child who is about to faint may feel dizzy, lightheaded, warm, clammy, or notice their vision beginning to darken. These symptoms occur when blood pressure drops and, for a brief period, less blood reaches the brain.

Benjamin Hale, MD, MS, CEPS-P, CCDS, a pediatric cardiologist at Stead Family Children's Hospital says some children are also more prone to fainting because of how their nervous system responds to certain triggers

Fainting can be frightening for parents, caregivers, coaches, and school staff to watch. But Breitbach says it is also common - more than 1 in 4 people may have a syncopal episode before age 25.

"The vast majority of episodes of syncope are not dangerous or emergent," she says. "They're scary to watch, but there is nothing dangerous happening."

Back-to-school routines can make dizziness or fainting more likely. Students may be waking up earlier, sleeping less, returning to sports, sitting through longer class blocks, skipping meals, or exercising before school.

"A lot of high schoolers also do early workouts before school, so if they don't eat or drink enough, they can have episodes either during the workout or the day of the recovery period," Breitbach says.

She says longer class periods - as many schools are shifting to block systems - can also contribute.

"They are sitting in their class for an hour and a half instead of 45 minutes," she says. "I've seen a lot more kids have issues with dizziness because they have to sit for so long."

Patterns can help providers understand what is happening. If a child tends to feel faint after standing for a long time, skipping breakfast, exercising without enough fluids, being overheated, or sitting for a long period, those details can help guide next steps.

"If we can find a clear trigger, that's really helpful to us," Hale says.

For many children and teens, lifestyle changes can help reduce dizziness, lightheadedness, or fainting episodes.

"Conservative management, increasing fluid, salt intake, better sleep, regular exercise are great steps," he says. "It gets the ball rolling by the time we see them."

Breitbach says hydration is especially important.

"If you drink enough water, a lot of these symptoms may go away," she says.

If a child faints, the first step is to help them stay safe, calm, and lying down. Do not rush them back to standing or walking.

"Sometimes lifting up the legs can help but just keep them kind of safe and calm and lying down," Hale said.

Breitbach says adults should avoid moving a child too quickly after they begin to wake up.

If it lasts longer, Hale says that can raise concern.

Then you have to start wondering if there's something else at play," he said.

After a child faints or nearly faints, the details matter. Parents, caregivers, school nurses, teachers, or coaches should try to remember what happened before, during, and after the episode. Hale says the story of what happened is often the most important part of the evaluation.

"Most of the time when we see a child who's passed out for some reason or another, we can make the diagnosis just by hearing the history," Hale says. "It is by far and away the most important way that we figure out what's going on."

When a child or teen has fainting, recurring dizziness, or concerning symptoms, a pediatrician or primary care provider is the best first step.

Breitbach says primary care providers can help determine whether the episode sounds like syncope, seizure, or something else.

"Primary care providers will know whether the story sounds concerning for a seizure or is more consistent with syncope," she says. "They can get them pointed in the right direction."

If a child is referred to pediatric cardiology, the evaluation often starts with the story of what happened.

• A pediatric cardiology evaluation may include:
• A detailed history of the episode
• A review of symptoms before and after fainting
• Family history
• A physical exam
• An electrocardiogram, or EKG
• Orthostatic vital signs, when autonomic dysfunction or POTS are concerns
• Additional testing, such as an echocardiogram or treadmill test, when needed

"We'll do a physical exam and make sure there's no obvious problems with the heart sounds," Hale says. "Everybody who comes into clinic for syncope will get an EKG."

He says not every child needs advanced testing.

"We don't always do more advanced testing, and I don't think patients should expect that," Hale says.

For some children, especially those with autonomic dysfunction or concern for POTS, Breitbach says orthostatic vital signs may be part of the visit.

"They also get orthostatic vital signs, which is a 10-minute standing test that they do every time they come and see me," Breitbach says.

While fainting can be common, details matter and pediatric providers can help decide whether further evaluation is needed.

"It's scary to watch, but not always life-threatening or emergent," Breitbach says. "Letting your pediatrician know when it happens is helpful."

Most fainting episodes are not dangerous, but certain patterns should be taken seriously.

Breitbach says emergency care may be needed if a child faints during activity, such as while running or playing basketball.

"If they're in the middle of a run, and they fall down, or a basketball court running back and forth and they have an episode then that is more concerning," she says. "Seeking emergency department-type treatment would be beneficial."

A significant head injury after fainting is another reason to seek emergency care.

ainting, dizziness, chest discomfort, or a racing heart during sports or physical activity should not be ignored. While many fainting episodes are common and not dangerous, exertion can be associated with more concerning heart-related causes.

"Syncope with activity is thought of as a red flag," Hale says.

He says exertion can be a trigger for certain rhythm conditions.

This matters for student athletes, who may feel pressure to play through symptoms during practice, conditioning, games, or competitions.

Most fainting and dizziness in children and teens is not dangerous, but parents do not have to determine the cause on their own. Keep track of what happened, encourage healthy hydration and routines, and tell your child's pediatrician. It is especially important to reach out to your child's provider if symptoms recur, happen during activity, or come with other concerning signs.